title: Importance of coronary artery spasm in alcohol-related unexplained syncope.
abstract: To examine the role of coronary artery spasm in patients with syncope after alcohol ingestion, we performed an intracoronary ergonovine provocation test in 7 male patients (39 to 73 years old, mean 54 years) with alcohol-related syncope which remained unexplained despite noninvasive cardiovascular and neurological examinations. No patients had structural heart disease or significant coronary artery stenosis. Ergonovine was continuously infused into each coronary artery at a rate of 10 micrograms/min for up to 5 min. Coronary artery spasm with ST-segment elevation was induced in 4 of 7 patients. Chest pain before syncope or history of chest pain were not present in 3 of 4 patients with a positive ergonovine test. Multivessel coronary artery spasm was induced in 3 patients. One patient presented with triple vessel coronary artery spasm progressing to near syncope as a result of profound hypotension and ventricular tachycardia during provocation. Coronary artery spasm was promptly relieved by intracoronary isosorbide dinitrate infusion. All patients with a positive ergonovine test were treated with calcium antagonist and did not experience syncope during follow-up. These results suggest that coronary artery spasm is one of the important causes of syncope after alcohol ingestion.
authors.affiliation: First Department of Internal Medicine, Niigata University School of Medicine, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Tanabe
authors.forename: M
authors.initials: M
authors.lastname: Yamazoe
authors.forename: Y
authors.initials: Y
authors.lastname: Igarashi
authors.forename: Y
authors.initials: Y
authors.lastname: Tamura
authors.forename: K
authors.initials: K
authors.lastname: Tsuchida
authors.forename: K
authors.initials: K
authors.lastname: Otsuka
authors.forename: H
authors.initials: H
authors.lastname: Uchiyama
authors.forename: T
authors.initials: T
authors.lastname: Shu
authors.forename: A
authors.initials: A
authors.lastname: Shibata
mesh_terms: D000328:Adult; D000368:Aged; D000434:Alcoholic Beverages / Q000009:adverse effects*; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D004562:Electrocardiography; D004874:Ergonovine; D006801:Humans; D008297:Male; D008875:Middle Aged; D013575:Syncope / Q000209:etiology* / Q000503:physiopathology
chemical_list: D004874:Ergonovine