ABSTRACT
Application of contrast cineventriculography and probe of the left ventricle indicated that there was a relationship between the status of myocardial contractility, its function, some hemodynamic parameters, the severity of regional left ventricular wall contractility impairments and the nature of a hemodynamic response to Valsalva's test. Normal left ventricular contractility determined sinusoidal responses. Decompensated impairments of myocardial contractility gave rise to a square wave. A response represented as a nil ++super-elevation was caused by a moderate impairment of left ventricular contractility and, probably, by the absence of adequate vasoconstriction in the fourth phase of Valsalva's test.
Subject(s)
Cardiomyopathy, Dilated/physiopathology , Coronary Disease/physiopathology , Hemodynamics/physiology , Myocardial Contraction/physiology , Ventricular Function, Left/physiology , Adult , Cardiomyopathy, Dilated/diagnosis , Cardiomyopathy, Dilated/etiology , Coronary Disease/complications , Female , Humans , Male , Middle Aged , Severity of Illness Index , Valsalva ManeuverABSTRACT
Changes in hemodynamics associated with Valsalva's test are responsible for a reduction in myocardial oxygen consumption and a decrease in diastolic coronary perfusion pressure in ischemic patients and subjects free of coronary heart disease. Due to stenosis and occlusion of coronary arteries lowering of perfusion coronary pressure in relevant patients becomes more profound and may induce ischemia in spite of diminished oxygen consumption. The main cause underlying onset of myocardial ischemia in patients with marked lesions of coronary arteries is initially low perfusion pressure and limited coronary reserve.
Subject(s)
Coronary Disease/etiology , Valsalva Maneuver/physiology , Adult , Blood Pressure/physiology , Coronary Circulation/physiology , Coronary Disease/diagnosis , Coronary Disease/physiopathology , Humans , Male , Middle AgedSubject(s)
Cardiomyopathy, Dilated/diagnosis , Coronary Disease/physiopathology , Myocardial Contraction/physiology , Valsalva Maneuver , Ventricular Function, Left/physiology , Adult , Cardiomyopathy, Dilated/etiology , Cardiomyopathy, Dilated/physiopathology , Coronary Disease/complications , Female , Hemodynamics/physiology , Humans , Male , Middle AgedSubject(s)
Angina Pectoris/physiopathology , Coronary Circulation , Angina Pectoris/etiology , Animals , Arterioles/physiopathology , Blood Platelets/physiology , Blood Pressure , Coronary Disease/physiopathology , Coronary Vessels/physiopathology , Epoprostenol/physiology , Humans , Hyperlipidemias/complications , Microcirculation/physiopathology , Platelet Aggregation , Rheology , Spasm/physiopathology , Stress, Physiological/complications , Stress, Psychological/complications , Thromboxane A2/physiology , Vascular Resistance , VasoconstrictionABSTRACT
Thirty-five patients including 26 with coronary heart disease and 9 with a pain syndrome non-typical of angina were studied. All patients were subjected to Valsalva's standardized test during which the pressure was measured in the aorta and the heart left ventricle paralleled by simultaneous ECG registration at the three standard leads and at AVR lead. The test sensitivity equalled 50%, the test specificity was 88.9%. Both healthy subjects and coronary heart disease patients displayed a reduction of the diastolic coronary gradient during Valsalva's test, mostly due to the increased diastolic pressure in the left ventricle, which corresponded to the dissemination of coronary atherosclerosis (by coronographic findings). The mechanisms contributing to the development of ischemia associated with Valsalva's test include a fall in coronary perfusion, tachycardia and the reflectory influence of the pulmonary receptors.
