Coronary artery spasm--1984

Coronary artery spasm: review and update

Coronary artery spasm (CAS), an intense vasoconstriction of coronary arteries that causes total or subtotal vessel occlusion, plays an important role in myocardial ischemic syndromes including stable and unstable angina, acute myocardial infarction, and sudden cardiac death. Coronary angiography and provocative testing usually is required to establish a definitive diagnosis. While the mechanisms underlying the development of CAS are still poorly understood, CAS appears to be a multifactorial disease but is not associated with the traditional risk factors for coronary artery disease. The diagnosis of CAS has important therapeutic implications, as calcium antagonists, not β-blockers, are the cornerstone of medical treatment. The prognosis is generally considered benign; however, recurrent episodes of angina are frequently observed. We provide a review of the literature and summarize the current state of knowledge regarding the pathogenesis of CAS.

Cardiovascular effects of Danshen

Danshen is one of the most versatile Chinese herbal drugs that have been used for hundred of years in the treatment of numerous ailments. Because of its properties of improving microcirculation, causing coronary vasodilatation, suppressing the formation of thromboxane, inhibiting platelet adhesion and aggregation, and protecting against myocardial ischemia, it is widely used either alone or in combination with other herbal ingredients for patients with coronary artery disease and other cardiovascular diseases, in both China and other countries including the United States. This article provides an overview of its history, pharmacology, pharmacokinetics, clinical applications, side effects, interactions with Western drugs, and future prospects in the management of cardiovascular diseases.

Mast cells in human coronary arteries; is there any correlation with luminal narrowing?

Histamine in the human coronary arteries is harboured in mast cells and possibly in a non-mast cell store. Upon histamine exposure atherosclerotic coronary arteries react differently than normal coronary arteries, and histamine has been proposed to provoke vasospasms, ischaemia and sudden cardiac death. Previous reports have indicated a correlation between the mast cell density and the histamine content on the one hand and the degree of atherosclerosis on the other hand. Since previous reports applied visual assessment of the luminal narrowing only, we reexamined these results utilising planimetric methods. The study was accomplished by examining coronary arteries from autopsy cases (50-70 years, N = 29) with a diagnosis of sudden death, myocardial infarction or a non-cardiac cause. The mast cell density was calculated as the ratio between the mast cell count and the adventitial area as seen by light microscopy, and was compared to the degree of luminal narrowing. We were not able to find any correlation between the mast cell density and the luminal narrowing. The myocardial infarction group had the most severe degree of luminal narrowing, but there was no significant difference in mast cell density between the groups. We therefore question the previous notion that there is a correlation between the adventitial mast cell density in the coronary arteries and the luminal narrowing. Earlier reports may have been biased by visual assessment and by erroneously treating several measurements from the same person as independent samples.