DIAGNOSIS OF DYNAMIC LESIONS

Rupture of atheromatous plaques, thrombosis and spastic contractions c ause dynamic lesions in coronary arteries. This review focuses on the diagnostic approach to vasospastic lesions. Our current knowledge cons iders vasospastic angina as a - most likey - localized disease of the vascular smooth muscle, which occurs in nonatherosclerotic as well as in atherosclerotic segments. Currently the diagnosis can only be prove n by functional tests under angiographical control. Since the pathophy siological mechanisms leading to vasospasm remain unclear, only empiri cally developed pharmacological tests are available. The use of ergono vine alkaloids is well established, the feasibility of acetylcholine i s under investigation. The reproducibility regarding the course of the disease and the localization of the lesion has not yet been determine d. The necessity to state the diagnosis is given by the improved progn osis of the disease under effective therapy with calcium channel block ers and nitrates.