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W. KUPPER Coronary artery vasoconstriction is not only the mechanism responsible for Prinzmetal's variant angina, but may also be involved in stable angina pectoris and myocardial infarction. However, the underlying patho-physiological mecha nisms and the importance of coronary vasoconstriction in these syndromes is still largely unknown. Several hypotheses have been proposed. Sympathetic nervous activity plays a key role in the regulation of coronary blood flow, but mechanical or humoral constrictive factors may be active as well. a-adrenergic tone Adrenergic nerve fibers accompany coronary vessels of any size. The stimulation of cardiac sympathetic nerves causes an increase in coronary blood flow. If, however, chronotropic and inotropic effects of adrenergic stimulation are sup pressed pharmacologically by beta-adrenoceptor blockade, a reduction in flow is observed. Thus, the primary effect of sympathetic stimulation on the coronary arteries is the alpha-adrenergic mediated vasoconstriction. Functionally inner vated alpha-adrenoceptors have been documented both in large coronary con ductance arteries and in the small resistance vessels. Animal studies and a human study have documented that a permanent constrictor tone is present on the coronary circulation both at rest and during exercise; this condition could be prevented with alpha-adrenoceptor blockade or was absent after heart transplan tation. Therefore, alpha-adrenoceptor mediated coronary constriction is an at tractive hypothesis as a possible pathophysiological mechanism of inappropriate coronary vasoconstriction and cororiary vasospasm.
List of contents
1. Introduction.- 2. Relation of coronary arterial spasm to sites of organic stenosis.- 3. The concept of dynamic coronary stenoses.- 4. Contribution of dynamic vascular wall thickening to luminal narrowing during coronary arterial vasomotion.- 5. Alteration in coronary vasomotor tone by alpha-stimulation.- 6. Regulation of large coronary arteries by beta adrenergic mechanisms in conscious dogs.- 7. The role of alpha-adrenergic activity in large and small coronary arteries in man.- 8. Adrenergic control of human coronary circulation.- 9. The effect of cardioselective beta blockade by metoprolol on the coronary vascular tone under endogenous catecholamine stimulation.- 10. Alpha-adrenergic receptors and coronary vasospasm.- 11. Enhanced transcardiac 1-norepinephrine response during cold pressor test in obstructive coronary artery disease.
