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Query: UMLS:C0009443 (cold)
 92,137 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Exposure to cold causes a vasoconstriction and a tachycardia, both resulting in a rise of blood pressure and cardiac work. This last effect may have a deleterious influence on people suffering from ischaemic heart disease (IHD). Moreover, coronary artery spasm could occur if vasoconstriction extends to the heart vessels. Epidemiologic studies have shown that mortality from IHD was correlated to the ambient temperature. There will be more deaths per day in the winter, and fewer in the summer. However, the daily number of deaths also increases during the heat waves. During a cold test, the coronary blood flow remains normal or slightly increased in normal subject. There is never a coronary artery spasm. Subjects who suffer from angina but have normal coronary arteries behave in the same way as normal subjects. Patients with IHD show a decrease in coronary blood flow. In a few cases, those patients may exhibit a coronary spasm with chest pain and even myocardial infarction. It is concluded that people with normal cardiovascular function are unaffected by cold stress whereas those with IHD may be crippled, although rarely, by exposure to cold, especially if they perform a physical work.
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PMID:Cold exposure and ischemic heart disease. 148 67

The effect of peripheral cold provocation on myocardial perfusion was evaluated utilizing thallium-201 perfusion imaging in 13 selected patients with arterial hyperreactivity (Raynaud's phenomenon: n = 8; migraine: n = 6) and angiographically documented coronary artery spasm. Eleven out of 13 subjects with coronary arterial spasm--but none of a group of patients with obstructive coronary artery disease--had transient myocardial perfusion defects during cold provocation. The localization of transient perfusion abnormalities during myocardial scintigraphy correlated with the myocardial areas distal to the spontaneous or ergonovine-induced coronary arterial spasm detected by angiography. Transient reduction of tracer uptake during cold provocation and normalization of myocardial perfusion by redistribution imaging was paralleled by areas of hypokinesia observed during the test by contrast ventriculography (n = 8). The described findings in the coronary system during peripheral cold pressor test occurred independently of the presence of Raynaud's phenomenon, and without achieving the ischemic threshold.
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PMID:Transient myocardial perfusion abnormalities during cold provocation test in patients with arterial hyperreactivity. 177 61

We report a 58-year-old male with a history of cardiac arrest due to coronary artery spasm, preoperative coronary arteriograms showed multivessel coronary spasm after the administration of ergonovine maleate associated with triple vessel fixed stenotic lesions. Under the use of cold diltiazem potassium-blood cardioplegic solution to prevent perioperative coronary spasm, coronary artery bypass grafting was performed. The right internal thoracic artery (ITA) was anastomosed to the left anterior descending artery and the left ITA to the circumflex artery. A saphenous vein graft was anastomosed to the right coronary artery. The postoperative course was uneventful. In postoperative coronary angiography with ergonovine stimulation, neither ITA grafts showed spastic changes, and the coronary artery distal to the anastomotic sites were well perfused through the ITA grafts. The patient has been free of angina without administration of calcium antagonist and been doing well for 2 years and 5 months since the operation.
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PMID:[A case of bilateral internal thoracic artery bypass grafting in sudden death survivor with multivessel coronary spasms]. 196 Apr 61

The comparative sensitivities of exercise (supine ergometer), isoproterenol (ISP) infusion and cold pressor test (CPT) for detecting myocardial ischemia in patients with effort angina (45 cases) and vasospastic angina (16 cases) were investigated. Twenty-three patients with atypical chest pain served as normal controls. Left ventricular function was evaluated by computerized quantitative analysis using the following three graphic methods: 1) radionuclide angiography during exercise (EX-RI) and ISP infusion (ISP-RI), 2) two-dimensional echocardiography during ISP infusion (ISP-2DE) and CPT (CP-2DE) and 3) digital subtraction angiography during CPT (CP-DSA). The incidence of regional wall motion abnormalities (WMA) induced by these three stress tests in patients with effort angina were as follows: 83% in EX-RI, 80% in ISP-2DE, 80% in ISP-RI, 75% in CP-2DE and 86% in CP-DSA. In patients with vasospatic angina, the WMA were as follows: 40% in EX-RI, 0% in ISP-RI and 71% in CP-DSA. In patients with atypical chest pain, the WMA were 0% in EX-RI, 0% in ISP-RI, 8% in ISP-2DE, 13% in CP-2DE and 13% in CP-DSA. The left ventricular ejection fraction (EF) was unchanged during ISP (from 65 +/- 11% to 68 +/- 12%) and it decreased both during exercise (from 64 +/- 10% to 58 +/- 9%, p less than 0.05) and during CPT (from 69 +/- 10% to 65 +/- 9%, p less than 0.05) in patients with effort angina. In patients with vasospastic angina, the EF was unchanged both during exercise (from 70 +/- 7% to 68 +/- 13%) and during the CPT (from 76 +/- 5% to 75 +/- 4%), while it increased during ISP infusion (from 63 +/- 8% to 79 +/- 7%, p less than 0.01). In patients with atypical chest pain, the EF was increased both during exercise (from 72 +/- 7% to 79 +/- 5%, p less than 0.01) and during ISP infusion (from 67 +/- 5% to 78 +/- 7%, p less than 0.01), while it was unchanged during CPT (from 77 +/- 7% to 76 +/- 8%). In exercise and in ISP infusion tests, WMA were provoked concomitantly with ST segment deviations in nearly all patients. However, during CPT, WMA were produced without the occurrence of ST segment deviations. Myocardial ischemia due to organic coronary artery stenosis was difficult to distinguish from coronary artery spasm by exercise test. However, the susceptibility to ISP infusion and CPT differed in producing WMA in patients with vasospastic angina.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Comparative sensitivities of exercise, isoproterenol infusion and cold pressor tests for detecting myocardial ischemia]. 332 25

This study was performed to evaluate pulmonary vascular reactivity in patients with angiographically documented coronary vasospasm. Right heart catheterization was performed in 8 subjects with vasospastic angina without evidence of Raynaud's phenomenon: heart rate, systemic and pulmonary arterial pressure as well as cardiac output were determined at rest, during cold provocation and after 20 minutes recovery. Data were obtained both before and during treatment with nifedipine. During cold provocation pulmonary vascular resistance was elevated significantly (P less than 0.02 compared with baseline); systemic vascular resistance tended to increase; nifedipine blunted both vasoconstrictor effects. Our results indicate an abnormal vascular response of the pulmonary arteries to cold provocation in patients with symptomatic coronary artery spasm and suggest a primary vasospastic disorder with coronary and pulmonary manifestation.
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PMID:Increase of pulmonary vascular resistance during cold provocation in patients with variant angina. 334 61

Provocative tests that permit detection of coronary artery spasm are widely used in patients with ischemic syndromes. To assess the usefulness of radionuclide ventriculography combined with provocative tests for diagnosis of coronary spasm, the left ventricular (LV) response to exercise, hyperventilation and a cold pressor test was determined in 3 groups. Group I included 10 normal subjects; group II, 49 patients with typical effort angina and fixed obstructive coronary artery disease at catheterization; and group III, 19 patients suspected of having vasospastic angina based on clinical and electrocardiographic findings, each of whom had normal coronary angiographic findings. In group I, LV ejection fraction (EF) increased during hyperventilation and exercise testing in 9 of 10 subjects (90%) and failed to decrease 5% in 9 of 10 subjects (90%) during cold testing. In contrast, while 18 of 49 patients (37%) of group II showed LV dysfunction with cold testing and 8% with hyperventilation, all showed abnormal LV function during exercise. Finally, in group III, LVEF increased during exercise, mimicking the response in normal group, while dysfunction was present in 14 of 19 (74%) during hyperventilation and in 17 of 19 (89%) during cold testing. When results of hyperventilation and cold testing were combined, abnormal responses were present in all patients. Thus, radionuclide ventriculography, when performed in association with 3 forms of stress--exercise, hyperventilation and cold testing--allows accurate identification of patients likely to have coronary spasm.
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PMID:Usefulness of radionuclide ventriculography in assessment of coronary artery spasm. 382 93

The effectiveness and safety of diltiazem (DIL), a slow channel calcium blocker, added in cold potassium cardioplegic (CP) solution was evaluated in coronary artery bypass graft (CABG) surgery for 2 purposes; (1) protection of ischemic myocardium during cardiac arrest and (2) prevention of perioperative coronary artery spasm (PCS). Diltiazem of 15 mg was added to a liter of CP which was administered 10 ml/kg B.W. initially and 5mg/kg thereafter. The serum concentration of DIL was 570 ng/ml at the time of aortic declamping, 210 ng/ml at cardioversion and 150 ng/ml one hour after surgery. The left ventricular stroke work index was increased significantly (p less than 0.05) in patients treated by DIL-CP, compared with the patients treated by regular CP without DIL. However, CPK-MB values were not significantly different in either group. The incidence of PCS has decreased from 9.1% to 0.8% (p less than 0.01) after the use of DIL-CP. Perioperative myocardial infarction rate has also decreased from 5.5% to 1.6%. No major or long-lasting side-effects were encountered. We consider that DIL-CP is a safe and excellent CP in CABG surgery and we are now utilizing this CP in all patients requiring CABG surgery.
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PMID:[Evaluation of the effectiveness and safety in the use of cold-diltiazem-potassium cardioplegia in coronary artery bypass surgery: a first clinical trial]. 391 Oct 52

Coronary artery spasm is provoked by exercise, cold pressor test and pharmacological agents during cardiac catheterization. We describe a patient in whom the coronary artery was excessively sensitive to cold pressor test, and who was treated by coronary artery bypass grafting (CABG) combined with cardiac denervation. Postoperative coronary arteriogram showed decreased sensitivity to cold pressor test with patent graft. These observations suggest that combined CABG with cardiac denervation is indicated for patients with fixed organic coronary artery narrowing and positive provocative test, and that postoperative cold pressor test during coronary arteriography is a useful, low risk method for the evaluation of the efficacy of cardiac plexectomy.
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PMID:Surgical treatment of variant angina with positive cold pressor test. 396 62

Although beta-adrenergic blocking agents reduce myocardial oxygen consumption and symptoms of myocardial ischemia in patients with coronary artery disease (CAD), propranolol has been reported to exacerbate coronary artery spasm in some patients with variant angina. To determine whether increased coronary vasomotor tone can be induced by beta-adrenergic blockade, we measured the changes in coronary vascular resistance (CVR) during cold pressor testing (CPT) in 15 patients, nine with severe CAD and six with normal left coronary anatomy, before and after i.v. propranolol (0.1 mg/kg). Coronary blood flow was measured by coronary sinus thermodilution. CVR was calculated as mean arterial pressure divided by coronary sinus blood flow. Heart rate was maintained constant at a paced subanginal rate of 95 +/- 5 beats/min. Before propranolol, CPT induced significant increases in coronary vascular resistance in patients with CAD (15.0 +/- 2.2%, p less than 0.02), but no increase in CVR in the normal patients. After propranolol, the CVR change during CPT was augmented for patients with CAD (29 +/- 6%, p less than 0.01) and for the normal population (9 +/- 5%, NS). The potentiated increase in CVR occurred without significant changes in resting CVR or in the magnitude of the hypertensive response to CPT. We conclude that beta-adrenergic blockade with propranolol can potentiate coronary artery vasoconstriction in some patients with CAD, possibly mediated by unopposed alpha-adrenergic vasomotor tone. These changes may be important in patients in whom intense adrenergic stimulation may increase coronary artery tone and adversely influence the balance between myocardial oxygen supply and demand.
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PMID:Potentiation of coronary vasoconstriction by beta-adrenergic blockade in patients with coronary artery disease. 613 36

The cold pressor test was used to induce myocardial ischaemia in patients with coronary artery disease and the rise in left ventricular filling pressure used as the index of myocardial ischaemia. Left ventricular filling pressure was derived from a non-invasive echophonocardiographic method. A study group of 19 consecutive patients with chest pain underwent the cold pressor test before coronary angiography. Eighteen responded with a rise in filling pressure exceeding 30% and, of these, 17 had serious coronary artery disease (three single vessel, one two vessel, and 13 triple vessel disease; one had coronary artery spasm only). The remaining patient, who showed no rise in filling pressure, did not have coronary artery disease. None of 15 normal controls showed a rise greater than 5% (patients with coronary artery disease versus normal controls p less than 0.001). The cold pressor test would be suitable for patients who cannot or should not exercise and may be combined with exercise electrocardiograms to improve the information content, as it uses a different marker of myocardial ischaemia.
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PMID:Cold pressor test in diagnosis of coronary artery disease: echophonocardiographic method. 640 37


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