Coronary spasm, steal, and stenosis: Implications for management of ischemic heart disease

1986 ◽  
Vol 11 (1) ◽  
pp. 5-67 ◽  
Author(s):  
Morton J. Kern ◽  
John T. Miller
1979 ◽  
Vol 07 (03) ◽  
pp. 197-236 ◽  
Author(s):  
V. Petkov

However great the success in the therapy of hypertension, atherosclerosis and ischemic heart disease has been gained today by recent efficient drugs, the definite healing of patients is not yet attained. The late discovery of reserpine, such an efficient drug of plant origin against hypertension, convinced so far reluctant scientists to consider the chemical compounds of the plant world. With respect to this traditional medical knowledge, it seems to define more accurately the specificity of these healings-sometimes recommended unspecifically for a whole branch of medicine. This experimental verification should not use inconsiderably the present-day classification of diseases; there should be an awareness that conventional experimental methods in pharmacology are often unsuitable for revealing the real biological activity of one or another medicinal plant. The interest in the mellennial empirical field of health care is acknowledged by the World Health Organization which promotes research and development of traditional medicine, along with investigations into its psychosocial and ethnographic aspects. These studies cover a number of plants growing in Bulgaria that have a healing effect in hypertension, atherosclerosis and ischemic heart disease according to the data of traditional medicine. Using screening methods, extracts and chemically pure substances were investigated; extraction was done with solvents such as water, ether, chloroform, dichloretan, ethanol, methanol, and acetone. Most of the experiments were carried out on anesthetized cats, rabbits and dogs. The substances tested were applied mainly intravenously, and in some experiments orally. Chronic experiments were also carried out on wakeful dogs with induced hypertension, on animals fed on an atherogenic diet, and on animals with induced arrhythmia and coronary spasm. Data are presented of clinical examination of some plants of active substances isolated from them. Major results of these studies are presented for the following plants: Garlic; Geranium; Hellebore; Mistletoe; Olive; Valerian; Hawthorn; Peucedanum arenarium; Periwinkle; Fumitory. For another 50 plants growing in Bulgaria and in other countries the author presents his and other investigators' experimental and clinical data about hypertensive, antiatheromatous and coronarodilatating action.


Author(s):  
A Maseri

Studies on angina at rest showing that an increase of myocardial demand beyond a fixed supply is not the only or even the most frequent cause of acute myocardial ischemia open a new avenue in our understanding of ischemic heart disease. Functional factors that transiently interfere with regional coronary blood supply, such as coronary spasm, seem to play a major role in determining the clinical events associated with coronary atherosclerotic heart disease. These functional factors appear to be the major cause of angina at rest, nocturnal, post-prandial and cold-induced angina and for variable threshold of exertional angina.Sudden death was also shown to be a possible consequence of coronary spasm which was shown to cause ventricular fibrillation and cardiac arrest during reversible ischemic episodes with or without anginal pain.Myocardial infarction consistently occurs in the same vascular bed shown to undergo transient ischemic episodes before the onset of the final, irreversible one. The transient episodes were shown to be caused by coronary spasm. The irreversible episode could not be relieved by intracoronary nitrates. A platelet mural thrombus was found at post mortem at the site of demonstrated persistent spasm.We suggest that coronary vasospasm and platelet aggregation may be responsible for the onset of acute myocardial infarction and, possibly, for the development of coronary thrombotic obstructions.Thus, the clinical manifestations of ischemic heart disease may largely depend on the presence and severity of functional factors, transiently and acutely interfering with flow, along with a variable degree of coronary atherosclerosis. In turn, prognosis may be determined by the severity of acute functional factors and the extent to which the coronary circulation and the myocardium are already chronically jeopardized by organic lesions.


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