Potential role of coronary vasoconstriction in ischaemic heart disease: effect of exercise

European Heart Journal
O M HessH P Krayenbühl

Abstract

Coronary vasomotion plays an important role in the regulation of coronary perfusion at rest and during exercise. Normal coronary arteries show coronary vasodilation of the proximal (+20%) and distal (+40%) vessel segments during supine bicycle exercise. However, patients with coronary artery disease show exercise-induced vasoconstriction of the stenotic vessel segments. The exact mechanism of exercise-induced stenosis narrowing is not clear but might be related to a passive collapse of the disease-free vessel wall (Venturi mechanism), elevated plasma levels of circulating catecholamines, an insufficient production of the endothelium-derived vasorelaxing factor or increased platelet aggregation due to turbulent blood flow with release of thromboxane A2 and serotonin. Various vasoactive drugs, such as nitroglycerin and calcium antagonists, prevent exercise-induced stenosis vasoconstriction. An additive effect on coronary vasodilation of the stenotic vessel segment was observed after combination of nitroglycerin with diltiazem. Thus, exercise-induced stenosis narrowing plays an important role in the pathophysiology of myocardial ischaemia during dynamic exercise. The antianginal effect of vasoactive substances can be explained--be...Continue Reading

Citations

Nov 21, 2007·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Thomas H Schindler, Heinrich H Schelbert
Aug 8, 2012·Circulation·Andreas J FlammerAmir Lerman
Sep 15, 2010·Cardiovascular Diabetology·Thomas W Jax
Feb 21, 2009·Journal of the American College of Cardiology·Heinrich R Schelbert
Nov 25, 2014·Cardiology in Review·Murugapathy VeerasamyVijay Kunadian
Oct 19, 2012·Current Opinion in Cardiology·David Glineur, Claude Hanet

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