PHYSIOLOGIC AND BIOCHEMICAL ASPECTS OF THE DISORDERED CORONARY CIRCULATION

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Abstract
Studies of the coronary circulation have been carried out in 50 patients, 23 of whom had angina pectoris. Coronary flow was shown to depend upon the need for O2 by the heart, and this, in turn, to be related to the hemodynamic and metabolic factors of that moment. Nitroglycerin, while causing a coronary vasodilatation in normals, failed to do so to any extent in patients with angina pectoris. Exercise had a variable effect in patients with angina pectoris. In those with no clinical pain or ecg changes, the increase of coronary flow was adequate to the needs. In those with angina and depressed S-T segments, myocardial ischemia was evidenced by a fall in coronary venous O2 saturation and the appearance of both lactate and pyruvate in coronary venous blood. Nitroglycerin effects in angina pectoris are probably attributable to modification of cardiac venous return and contractility, and depression of hemodynamic change on effort.

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