Coronary vasospasm. Observations linking the clinical spectrum of ischemic heart disease to the dynamic pathology of coronary atherosclerosis

• Patients with angina, myocardial infarction, and sudden death almost always have demonstrable coronary atherosclerosis. Furthermore, there is mounting evidence that coronary artery "spasm" is a contributing feature of these different coronary ischemic syndromes. Using quantitative angiography and two modes of α-adrenergic stimulation in patients with spontaneous rest angina, vasomotor hyperreactivity was shown to be localized only to the region of a preexisting coronary atheroma. These observations support the hypothesis that a dynamic interaction between the histopathologic features of coronary atherosclerosis and "normal" amounts of coronary smooth-muscle shortening accounts for the clinical features in the great majority of cases in the spectrum of ischemic heart disease. There are various mechanisms of smooth-muscle shortening in an arterial stenosis, each with different therapeutic implications. (Arch Intern Med1981;141:716-722)