Adv. Cardiol., vol. 26, pp. 44-54 (Karger, Basel 1979)
Clinical Use of Provocative Pharmacoangiography in Patients with Chest Pain C. RICHARD CONTI, R. CHARLES CURRY, LEONARD
and CARL J.
G.
CHRISTIE
PEPINE
Division of Cardiology, University of Florida, College of Medicine, JMH Health Center, Gainesville, Fla.
I. Introduction
In recent years, several workers have documented coronary artery spasm occurring during spontaneous episodes of chest pain [1]. These episodes of dynamic coronary occlusion may be accompanied by transient electrocardiographic abnormalities, usually ST segment elevation. In clinical practice, it is often difficult to record an electrocardiogram during an episode of spontaneous chest pain since the attacks may be infrequent and they often occur at night. Thus, it would be clinically useful to have a pharmacologic agent that would reliably and safely reproduce the clinical syndrome resulting from dynamic coronary obstruction. Numerous provocative tests have been tried, but at the present time only ergonovine maleate is widely used in this country [2]. This drug offers several advantages over other provocative tests; for example, when given as an intravenous bolus its coronary smooth, muscle constrictor action has rapid onset, peaking in 3-5 min, and is rapidly reversed by sublingual nitroglycerin. The purpose of this paper is to report our experience using ergonovine maleate in 130 patients undergoing diagnostic cardiac catheterization.
All patients were unpremedicated prior to cardiac catheterization. Following standard hemodynamic and angiographic study, ergonovine maleate, 0.05-0.2 mg, was given as an intravenous bolus injection. Blood pressure, heart rate, ECG and symptoms were observed over a 3- to 5-min period.
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II. Protocol
Provocative Pharmacoangiography
45
If no response was noted, the dose of ergonovine was increased up to a cumulative dose of 0.2 mg. Coronary angiography was repeated after the highest dose was administered or if the patients developed chest pain and ST segment elevation.
III. Hemodynamic Effects of Ergonovine Figures la-c are single patient examples to illustrate the time, course of action of intravenous ergonovine on heart rate, blood pressure, ST segment,
"'t:':/~~' ~r~:::~~-~~~~:~:::Il~;-. - cHEtr PA'iw ::C
_ /--.--
::~!
BLOOD PRESSURE (mmHg ) 100 80 60
.....-4-~'-+----+---4 ~~~~--~~~~
40
1 .. ~ LE(~m)m 2~L--I.""",.""""".___ ~~ -.-,,:;-_·-,:;:·;.:.i'..:;::,:..:;;;.Yo;.""-'•• ""'··_'· ...·.......-...:-~.:.~:O:-"'~,~,~,:+,~,_. hT
a
7
0 5_
-I 0
2
6
10
12
14
16
18
20
22
24
MINUTES NITROGLYCERIN
NITIOGlYCU IN UGONOVINE
RATE
Ib',/m;nl
ERGONOVINE O. OSmv
l:l 0_2~
100
80
90
70
HE ART RATE
::~l
b
80
SO
100
51
BLOOD
0
·s
CHEST PAIN
60
60
Imml
O~mo
Ibis/min ) 70
BLOOD PRESSURE 100 Imm Hg) 80
tsT V2
•
,
-1 0
, • 6 MINUTES
10
PRESSU RE 80 (mmHg) 60
12
tST VA
(mm l
20
10 O~-r~~~~~~~~
-I 0 I 2 3
4 5 6 MINUTES
7 108 II 912
Fig. 1 a---c. Single patient examples of the time course of action of intravenous ergonovine on heart rate, blood pressure, ST segment changes, and chest pain.
Downloaded by: University of Cambridge 131.111.164.128 - 3/19/2019 6:55:16 AM
HEART
0-8':."
o~ m9
46
CONTI/CURRY /CHRISTIE/PEPINE
120
170
. '. .' ..-..' ' , ' ..'
100 E ".a ",-
c ;; 0 c
80
0 E' 60 I
ti
d:
01 I
E E
i":J
:ii i"
~
p=NS
.0 C
m
4-0
~
4-0
105
"-
+1%
•
'"
.'
60
80
100
4-0~------~~--------.
40
120
105
170
Mean blood pressure, mm Hg
Heart rate, bpm Pre-ergonovine
Fig. 2. Heart rate and blood pressure responses after intravenous ergonovine.
15
E
... .. . . ... .... ..
7.5
E
01-
.t; > o c o
E' 01
p
Clinical Use of Provocative Pharmacoangiography in Patients with Chest Pain C. RICHARD CONTI, R. CHARLES CURRY, LEONARD
and CARL J.
G.
CHRISTIE
PEPINE
Division of Cardiology, University of Florida, College of Medicine, JMH Health Center, Gainesville, Fla.
I. Introduction
In recent years, several workers have documented coronary artery spasm occurring during spontaneous episodes of chest pain [1]. These episodes of dynamic coronary occlusion may be accompanied by transient electrocardiographic abnormalities, usually ST segment elevation. In clinical practice, it is often difficult to record an electrocardiogram during an episode of spontaneous chest pain since the attacks may be infrequent and they often occur at night. Thus, it would be clinically useful to have a pharmacologic agent that would reliably and safely reproduce the clinical syndrome resulting from dynamic coronary obstruction. Numerous provocative tests have been tried, but at the present time only ergonovine maleate is widely used in this country [2]. This drug offers several advantages over other provocative tests; for example, when given as an intravenous bolus its coronary smooth, muscle constrictor action has rapid onset, peaking in 3-5 min, and is rapidly reversed by sublingual nitroglycerin. The purpose of this paper is to report our experience using ergonovine maleate in 130 patients undergoing diagnostic cardiac catheterization.
All patients were unpremedicated prior to cardiac catheterization. Following standard hemodynamic and angiographic study, ergonovine maleate, 0.05-0.2 mg, was given as an intravenous bolus injection. Blood pressure, heart rate, ECG and symptoms were observed over a 3- to 5-min period.
Downloaded by: University of Cambridge 131.111.164.128 - 3/19/2019 6:55:16 AM
II. Protocol
Provocative Pharmacoangiography
45
If no response was noted, the dose of ergonovine was increased up to a cumulative dose of 0.2 mg. Coronary angiography was repeated after the highest dose was administered or if the patients developed chest pain and ST segment elevation.
III. Hemodynamic Effects of Ergonovine Figures la-c are single patient examples to illustrate the time, course of action of intravenous ergonovine on heart rate, blood pressure, ST segment,
"'t:':/~~' ~r~:::~~-~~~~:~:::Il~;-. - cHEtr PA'iw ::C
_ /--.--
::~!
BLOOD PRESSURE (mmHg ) 100 80 60
.....-4-~'-+----+---4 ~~~~--~~~~
40
1 .. ~ LE(~m)m 2~L--I.""",.""""".___ ~~ -.-,,:;-_·-,:;:·;.:.i'..:;::,:..:;;;.Yo;.""-'•• ""'··_'· ...·.......-...:-~.:.~:O:-"'~,~,~,:+,~,_. hT
a
7
0 5_
-I 0
2
6
10
12
14
16
18
20
22
24
MINUTES NITROGLYCERIN
NITIOGlYCU IN UGONOVINE
RATE
Ib',/m;nl
ERGONOVINE O. OSmv
l:l 0_2~
100
80
90
70
HE ART RATE
::~l
b
80
SO
100
51
BLOOD
0
·s
CHEST PAIN
60
60
Imml
O~mo
Ibis/min ) 70
BLOOD PRESSURE 100 Imm Hg) 80
tsT V2
•
,
-1 0
, • 6 MINUTES
10
PRESSU RE 80 (mmHg) 60
12
tST VA
(mm l
20
10 O~-r~~~~~~~~
-I 0 I 2 3
4 5 6 MINUTES
7 108 II 912
Fig. 1 a---c. Single patient examples of the time course of action of intravenous ergonovine on heart rate, blood pressure, ST segment changes, and chest pain.
Downloaded by: University of Cambridge 131.111.164.128 - 3/19/2019 6:55:16 AM
HEART
0-8':."
o~ m9
46
CONTI/CURRY /CHRISTIE/PEPINE
120
170
. '. .' ..-..' ' , ' ..'
100 E ".a ",-
c ;; 0 c
80
0 E' 60 I
ti
d:
01 I
E E
i":J
:ii i"
~
p=NS
.0 C
m
4-0
~
4-0
105
"-
+1%
•
'"
.'
60
80
100
4-0~------~~--------.
40
120
105
170
Mean blood pressure, mm Hg
Heart rate, bpm Pre-ergonovine
Fig. 2. Heart rate and blood pressure responses after intravenous ergonovine.
15
E
... .. . . ... .... ..
7.5
E
01-
.t; > o c o
E' 01
p
