[Sympathetic activity in patients with coronary insufficiency].

Twelve healthy control subjects, 9 cardiac patients with normal central hemodynamics, 9 patients with impaired left-ventricular contractility during exercise, and 10 patients with impaired contractility and coronary insufficiency (anginal pain and ST-segment depression of ECG) were investigated. Central hemodynamic values (Swan-Ganz catheter) as well as free plasma catecholamines noradrenaline and adrenaline were simultaneously determined at rest and during incremental exercise. At rest, no significant differences were observed between all groups. The cardiac patients with normal central hemodynamics also did not show any significant differences in their plasma catecholamine responses during exercise as compared with healthy control subjects. Patients with impaired left-ventricular contractility, indicated by a significantly increased pulmonary capillary wedge pressure, as reference value of increased left ventricular end-diastolic pressure, both with negative and positive indicators of coronary insufficiency during exercise, showed significantly higher noradrenaline levels at identical work loads than control subjects. However, adrenaline responses were only significantly higher in patients with positive indicators of coronary insufficiency during exercise. The noradrenergic responses may be triggered by a borderline reduction of cardiac output as well as by increased pressures in the low-pressure system. The over-proportional adrenergic responses may be an indicator of precordial anginal pain and anxiety. This reaction is seen to be significant for a further increase in myocardial oxygen demands and anginal pain.