Refractory Prinzmetal Angina Treated with Cyproheptadine
Authors: Alison D. Schecter
Journal: Annals of Internal Medicine (1994)

Brief Communications15 July 1994Refractory Prinzmetal Angina Treated with CyproheptadineAlison D. Schecter, MD, James H. Chesebro, MD, and Valentin Fuster, MD, PhDAlison D. Schecter, MDFrom Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts., James H. Chesebro, MDFrom Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts., and Valentin Fuster, MD, PhDFrom Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-121-2-199407150-00006 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Serotonin, 5-hydroxytryptamine, is an important modulator of coronary vascular tone [1]. It is avidly taken up from the plasma by platelets, stored in dense granules, and released during platelet aggregation and activation. Serotonin causes vasodilatation in normal coronary arteries and mild vasoconstriction in patients with stable angina. In patients with Prinzmetal or variant angina (a syndrome of chest pain at rest associated with ST elevation), serotonin at physiologic concentrations causes an exaggerated response of occlusive vasospasm [2]. We successfully treated two patients who had documented severe refractory variant angina with cyproheptadine (Periactin; Merck & Co., West Point, Pennsylvania), a nonselective ...References1. Vanhoutte PM. Platelet-derived serotonin, the endothelium, and cardiovascular disease. J Cardiovasc Pharm. 1991; 17(Suppl 5): S6-12. Google Scholar2. McFadden EP, Clarke JG, Davies GJ, Kaski JC, Haider AW, Maseri A. Effect of intracoronary serotonin on coronary vessels in patients with stable angina and patients with variant angina. N Engl J Med. 1991; 324:648-54. Google Scholar3. Shimokawa H, Vanhoutte PM. Angiographic demonstration of hyperconstriction induced by serotonin and aggregating platelets in porcine coronary arteries with regenerated endothelium. J Am Coll Cardiol. 1991; 17:1197-202. Google Scholar4. Drouet L, Sollier BD, Ruton S, Pignaud G. Role of serotonin in arteriolar thrombosis and secondary vasospasm. J Cardiovasc Pharm. 1990; 16(Suppl 3):S49-53. Google Scholar5. YamamotoY, Tomoike H, Egashira K, Nakamura M. Attenuation of endothelium-related relaxation and enhanced responsiveness of vascular smooth muscle to histamine in spastic coronary arterial segments from miniature pigs. Circ Res. 1987; 61:772-8. Google Scholar6. De Caterina R, Carpeggiani C, L'Abbate A. A double-blind, placebo-controlled study of kantaserin in patients with printzmetal's angina. Evidence against a role for serotonin in the genesis of coronary vasospasm. Circulation. 1984; 69(5):889-94. Google Scholar7. Willerson JT. Serotonin and thrombotic complications. J Cardiovasc Pharmac. 1991; 17(Suppl 5):S13-20. Google Scholar8. Nagasawa K, Tomoike H, Hayashi Y, Yamada A, Yamamoto T, Nakamura M. Intramural hemorrhage and endothelial changes in atherosclerotic coronary artery after repetitive episodes of spasm in x-ray-irradiated hypercholesterolemic pigs. Circ Res. 1989; 65:272-82. Google Scholar9. Lerman A, Webster MW, Chesebro JH, Edwards WD, Wei CM, Fuster V, et al. Circulating and tissue endothelin immunoreactivity in hypercholesterolemic pigs. Circulation. 1993; 88:2923-8. Google Scholar10. Peroutka SJ. Receptor "families" for 5-hydroxytryptamine. J Cardiovasc Pharm. 1990; 16(Suppl 3):S8-14. Google Scholar Author, Article, and Disclosure InformationAuthors: Alison D. Schecter, MD; James H. Chesebro, MD; Valentin Fuster, MD, PhDAffiliations: From Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts.Corresponding Author: Valentin Fuster, MD, PhD, Cardiovascular Institute, Mount Sinai Medical Center, Box 1030, One Gustave Levy Place, New York, NY 10029.Acknowledgments: The authors thank Dr. Arthur Kennish for help in preparing this report. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCyproheptadine in the treatment of reversible cerebral vasoconstriction syndromeCuring the incurable: A case of refractory vasospastic anginaSome observations on and controversies about coronary arterial spasmNONINVASIVE STRESS TESTING.Directional coronary atherectomy for coronary artery spasm refractory to medical therapyElucidation off the role of plaque instability and rupture in acute coronary eventsLewis A. Conner Memorial Lecture. Mechanisms leading to myocardial infarction: insights from studies of vascular biology. 15 July 1994Volume 121, Issue 2Page: 113-114KeywordsAnginaBlood plasmaCatheterizationEndotheliumIschemiaNitratesPlatelet aggregationPlateletsSerotoninVasoconstriction ePublished: 15 August 2000 Issue Published: 15 July 1994 Copyright & PermissionsCopyright © 1994 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...