Effects of ergonovine in patients with and without coronary artery disease.

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Abstract
The clinical, hemodynamic, ECG and coronary angiographic effects of ergonovine [a smooth muscle constrictor] was studied in 60 selected patients undergoing angiography. The patients were equally divided, 30 with coronary artery disease (CAD), lesions .gtoreq. 50% and 30 with minimal (< 50%) or no CAD. Ergonovine (0.05-0.4 mg i.v. bolus) was given while each patient was monitored for symptoms and changes in ECG, heart rate, QTc intervals, blood pressure and coronary diameter. After ergonovine, 18 patients developed chest pain, 8 of whom had associated ST-segment shifts (.gtoreq. 1 mm). Heart rate and QTc showed no significant change. Systolic blood pressure increased from 133 mm Hg (mean) to 147 mm Hg (P < 0.01). The mean diameter of 164 coronary arteries examined decreased 18% (P < 0.001) after ergonovine. Five patients with documented variant angina all developed typical chest pain and ST-segment shifts following ergonovine. Spasm of the anterior descending evoked with ergonovine was similar in location and magnitude to spasm occurring during spontaneous pain (2 patients). Thus, the ergonovine test appears sensitive in confirming the presence of variant angina. No serious problems requiring therapy other than nitroglycerin arose following ergonovine. Nonetheless, its use is not recommended outside the cardiac catheterization laboratory. Prolonged chest pain and myocardial infarction following ergonovine are possible complications in patients with severe CAD and/or variant angina.

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