The Intermediate Coronary Syndrome

In 23 patients with the intermediate coronary syndrome hypertension and an increased heart rate were common during pain. Clinical signs of acute left ventricular failure appeared in 1/3 of the patients. Electrocardiograms uniformly showed ST-segment changes or T-wave inversion or both. Coronary angiography revealed lesions similar to those seen during the chronic stage of coronary disease in all but one patient. Collateralization, however, occurred less frequently than expected. Left ventriculography exhibited only moderately abnormal function. Of 20 patients treated by beta-adrenergic blockade with propranolol 17 had prompt relief of pain, with lowering of blood pressure and heart rate. Seven patients with acute left ventricular failure showed clinical resolution during blockade. Fourteen patients eventually underwent revascularization surgery. Effective and safe treatment with beta-adrenergic blockade thus seems possible for most patients with the intermediate coronary syndrome. Revascularization surgery may then be considered on an elective basis. (N Engl J Med 288:1193–1198, 1973)