Myocardial response to cigarette smoking in normal subjects and patients with coronary disease

The myocardial and peripheral hemodynamic effects of cigarette smoking have been assessed during a steady state situation in a group of normal subjects, and compared with a group of patients with coronary artery disease. During smoking, in both groups there was augmentation of heart rate, systemic arterial pressure, and left ventricular work, this response being somewhat greater in the coronary patients. Despite these hemodynamic alterations, neither group had a significant change in coronary blood flow, so that myocardial oxygen usage remained virtually identical with the value before smoking. There was no evidence of myocardial ischemia in the coronary subjects during smoking. The various factors, potentially responsible for the lack of myocardial blood flow increment are considered.