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Reversible Cold-Induced Abnormalities in Myocardial Perfusion and Function in Systemic Sclerosis

ELAINE L. ALEXANDER, M.D., Ph.D.; GARY S. FIRESTEIN, M.D.; JAMES L. WEISS, M.D.; RICHARD R. HEUSER, M.D.; GEORGE LEITL, M.D.; HENRY N. WAGNER Jr., M.D.; JEFFREY A. BRINKER, M.D.; ALLEN A. CIUFFO, M.D.; and LEWIS C. BECKER, M.D.
[+] Article and Author Information

Grant support: by grants R01AM25650 and HL34723 from the National Institutes of Health and Ischemic Heart Disease Score USPHS Grant.

▸Requests for reprints should be addressed to Elaine L. Alexander, M.D., Ph.D.; The Johns Hopkins University School of Medicine, Division of Clinical Immunology, The Good Samaritan Hospital, 5601 Loch Raven Boulevard; Baltimore, MD 21239.


Baltimore, Maryland; and San Diego, California


© 1986 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1986;105(5):661-668. doi:10.7326/0003-4819-105-5-661
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The effects of peripheral cold exposure on myocardial perfusion and function were studied in 13 patients with scleroderma without clinically evident myocardial disease. Ten patients had at least one transient, cold-induced, myocardial perfusion defect visualized by thallium-201 scintigraphy, and 12 had reversible, cold-induced, segmental left ventricular hypokinesis by two-dimensional echocardiography. The 10 patients with transient perfusion defects all had anatomically corresponding ventricular wall motion abnormalities. No one in either of two control groups (9 normal volunteers and 7 patients with chest pain and normal coronary arteriograms) had cold-induced abnormalities. This study is the first to show the simultaneous occurrence of cold-induced abnormalities in myocardial perfusion and function in patients with scleroderma. The results suggest that cold exposure in such patients may elicit transient reflex coronary vasoconstriction resulting in reversible myocardial ischemia and dysfunction. Chronic recurrent episodes of coronary spasm may lead to focal myocardial fibrosis.

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