Hemodynamic and Myocardial Metabolic Effects of Ergonovine in Patients with Chest Pain

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Abstract

SUMMARY The effect of ergonovine on left ventricular hemodynamic and lactate-pyruvate measurements was studied in twenty-six patients. Patients were divided into two groups: Group 1 (seven patients) had a welldocumented variant angina syndrome and Group 2 (19 patients) had other chest pain syndromes. Ergonovine was given as the following were evaluated: symptoms, electrocardiographic changes, left ventricular pressure, myocardial lactate-pyruvate metabolism and coronary artery diameter changes. Chest pain and ST elevation occurred following ergonovine in all seven Group 1 patients. Left ventricular end-diastolic pressure increased (14-26 mm Hg mean, P < 0.05) and lactate extraction decreased (24% to -7%, P < 0.05). Subtotal or total dynamic obstruction of a major coronary artery occurred in each of the six Group 1 patients in whom coronary angiography was repeated during pain. In each case the location of ST elevation corresponded to the area perfused by the dynamically obstructed vessel. In Group 2 following ergonovine 13 patients remained asymptomatic, while six developed chest pain without ST changes. Left ventricular systolic and end-diastolic pressure increased (126-138 mm Hg and 14-17 mm Hg mean, respectively, both P < 0.05) associated with a minimal diffuse coronary vasoconstriction. Lactate-pyruvate metabolism remained unchanged. No differences were noted between Group 2 patients with and without chest pain following ergonovine.

Thus, only in patients with documented variant angina did ergonovine induce chest pain with ST elevation associated with hemodynamic and metabolic evidence for myocardial ischemia concomitant with subtotal or total dynamic coronary artery narrowing. In other patients only minimal generalized coronary vasoconstriction without metabolic evidence for myocardial ischemia occurred following ergonovine, regardless of the presence or absence of chest pain.

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