Coronary artery spasm: a mechanism of chest pain in selected patients with the mitral valve prolapse syndrome.

A group of 14 patients with mitral valve prolapse syndrome was referred for coronary angiographic study. The group was selected on the basis that all members had recurrent chest pain as their chief complaint and all had interpreted their chest pain as serious enough to warrant at lest two previous emergency visits to medical facilities in the six months preceding the study. All were found to have normal left ventricular function, and only one had a significant fixed obstructive coronary lesion. Seven of 14 patients (50 percent) showed evidence of coronary artery spasm during the catheterization study, five of whom had histories highly suggestive of coronary vasospasm. During the catheterization, spasm occurred spontaneously in three patients, ws ergonovine-induced in two, and was catheter-tip-induced in two. Ergonovine was administered to nine of the 14 patients. The drug induced vasospasm in two patients but failed in seven (two of whom had previously demonstrated catheter tip spasm). Of those seven patients who showed evidence of spasm, four had typical chest pain in association with reversible ST segment elevation and manifested a variant anginal syndrome.