Coronary arterial angiographic findings during transient myocardial ischemia.

Coronary arteriography remains the most precise clinical tool for diagnosis and therapeutical decision concerning patients with coronary artery disease; when performed during a short transient episode of myocardial ischemia, this investigation can afford interesting information. The first part of the paper describes the coronary arterial angiographic findings during ischemia related to increase in myocardial requirements. Thus, a vasoconstrictor reflex can decrease the area of narrowing during handgrip exercise. Other reports have described coronary arterial spasm during exercise in highly selected patients. Coronary arterial angiographic findings during transient decrease of coronary blood flow are described in the second part of this paper. They can rarely be detected spontaneously but most often are provoked. The results obtained with cold pressor, hyperventilation and ergonovine tests are discussed. In this latter provocative test, the incidence of spasm in a population of 2572 patients undergoing coronary angiography is described.