Spasm of the retinal vessels in association with unstable primary angina.

The role ofvasospasm, with or without associated coronary arterial stenosis, in causation of angina is an established fact at present. Circadian variation in the coronary arterial resistance has also been well documented. Association of spasm of the retinal arteries with primary and unstable angina, a significant and interesting phenomenon, was first observed by us in May, 1982 in a man aged 41 years. He had severe chest pain in May, 1982 and was diagnosed as having an inferior wall infarction. Ophthalmoscopic examination was performed 24 hrs after the attack ofpain. The fundus showed marked spasm in most of the arteries in both eyes. The patient was kept on 2-hourly doses of isosorbide dinitrate (Isordil), heparin and nifedipine (Adalat). The pain continued to occur at intervals for the next 72 hrs. During this period, the spasm was still present in the retinal vessels, but to a lesser degree. After 72 hrs, the vessels appeared fairly well dilated and the chest pain had also gone. During the last 1Y2 years, periodic examinations have revealed that there is occasional chest pain, and if a fundus examination is made at the time, there is spasm in some of the branches of the retinal vessels. With the administration of sublingual isosorbide dinitrate (Sorbitrate), there is relief, both in the pain, as well as the spasm of the retinal vessels. The patient was a heavy smoker and still smokes occasionally. While smoking, the spasm increases, but 5 mm later it disappears. Subsequently, we have observed this association in at least 25 patients. All are men below the age of 50 years. None of these patients had any history of hypertension. The spasm of the retinal arteries was mostly segmental and occasionally generalized, associated with transient blurring ofvision in a small number of cases. The retinal vasospasm has a correlation with the anginal pain. With coronary vasodilators and calcium antagonists, viz, nitroglycerine, nifedipine, verapamil, etc, and the relief of symptoms, the retinal arteries became normal in every case. In fact, it was even possible to adjust the requirement ofthe anti-anginal drugs watching the state of the retinal arteries. The above observation is especially useful in patients below the age of 50 years. The association of cigarette smoking and vasospasm, as observed in a few patients, deserves special consideration. As we do not have facilities to take retinal photographs, we are unable to document this observation which was confirmed in every case by the ophthalmologist co-author of this communication. We should like to know if this phemonenon has been studied and documented properly in any other center, so that the specificity of our observation can be critically assessed.