[An approach to the diagnosis of coronary artery spasm in spontaneous angina pectoris (author's transl)].

Spontaneously occurring spasms are more likely to be detected by performing coronary angiography during an acute ischaemic attack. This was achieved in 28 out of 41 cases. Spasm was found to be present in 23/25 attacks with elevated S-T segment but in only 5/16 attacks with other changes on ECG. The difference was statistically significant (p less than 0.01). When coronary angiography was performed outside anginal attacks, arterial spasm was detected in 16 out of 1071 cases (1.48%). The percentage increased in patients with spontaneous angina: 13/15 cases (8.6%). These spontaneous spasms are painless and can be differentiated from catheter-induced spasms and organic stenosis by the nitroglycerin test. Spasms which do not occur spontaneously can be provoked by methylergometrine maleate. This was done 175 time with 16 positive results. The criteria of positivity of the test, as well as its value, indications and dangers are discussed.