HYPERVENTILATION-INDUCED SIMULTANEOUS MULTIVESSEL CORONARY SPASM IN PATIENTS WITH VARIANT ANGINA - AN ECHOCARDIOGRAPHIC AND ARTERIOGRAPHIC STUDY

Left ventricular wall motion abnormalities during an attack of coronary spasm induced by hyperventilation were examnied with the use of two-dimensional echocardiography in 27 patients with variant angina. Transient abnormal wall motion (asynergy) confined to one coronary artery region was found in 18 of the 27 patients and transient abnormal motion extending over more than one coronary artery region in the remaining 9 patients. Spasm of more than one major coronary artery was demonstrated separately by coronary arteriography during an attack induced by injection of acetylcholine or ergonovine in seven of the nine patients who manifested asynergy in more than one coronary artery region. In one patient, spasm was demonstrated in one major coronary artery, and the other coronary arteries were severely stenosed or occluded organically. In the remaining patient, acetylcholine was not injected into both arteries; however, the attack was sometimes associated with ST segment elevation in the anterior leads and at other times in the inferior leads. Therefore, simultaneous multivessel coronary spasm seems to have occurred in eight of the nine patients who exhibited asynergy in more than one coronary artery region. The 8 patients with simultaneous multivessel coronary spasm had a higher degree and longer duration of ST segment elevation and a higher incidence of arrhythmias during the attack induced by hyperventilation than did the 19 patients with single vessel coronary spasm, and all of them had no significant organic stenosis. It is concluded that 1) simultaneous multivessel coronary spasm seems to occur in a sizable proportion (30%) of patients wtih variant angina and can be detected by two-dimensional echocardiography; and 2) an attack of simultaneous multivessel coronary spasm is associated with more severe and more prolonged myocardial ischemia than that of single vessel coronary spasm and it typically occurs in normal or nearly normal coronary arteries.