Angina Pectoris, Variant ; metabolism ; physiopathology ; Coronary Vasospasm ; metabolism ; Dyslipidemias ; metabolism ; physiopathology ; Humans

Angina Pectoris, Variant ; physiopathology ; Arrhythmias, Cardiac ; Electrocardiography ; Humans ; Male ; Middle Aged

Aged ; Angina Pectoris, Variant ; physiopathology ; Coronary Vasospasm ; physiopathology ; Coronary Vessels ; physiopathology ; Humans ; Male

Coronary vasospasm plays an important role in the pathogenesis not only of variant angina, but also of ischemic heart disease in general, including other forms of angina pectoris, acute myocardial infarction, and sudden death. Vasoactive events leading to an acute reduction in regional myocardial flow in the presence of a normal or previously compromised circulation are a common cause of arrhythmias. However, coronary vasospasm-induced electrical and mechanical complications are rarely reported in patients with angiographically normal or near-normal coronary arteries. This paper presents our experience with a patient presenting with coronary vasospasm-associated ventricular fibrillation without findings of significant coronary artery disease.
Angina Pectoris ; Angina Pectoris, Variant ; Arrhythmias, Cardiac ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels ; Death, Sudden ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Ventricular Fibrillation

Coronary vasospasm plays an important role in the pathogenesis not only of variant angina, but also of ischemic heart disease in general, including other forms of angina pectoris, acute myocardial infarction, and sudden death. Vasoactive events leading to an acute reduction in regional myocardial flow in the presence of a normal or previously compromised circulation are a common cause of arrhythmias. However, coronary vasospasm-induced electrical and mechanical complications are rarely reported in patients with angiographically normal or near-normal coronary arteries. This paper presents our experience with a patient presenting with coronary vasospasm-associated ventricular fibrillation without findings of significant coronary artery disease.
Angina Pectoris ; Angina Pectoris, Variant ; Arrhythmias, Cardiac ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels ; Death, Sudden ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Ventricular Fibrillation

Variant angina is characterized by spontaneous episodes of angina, usually occurring in the morning and having ST segment elevation on the electrocardiogram. However, in the case presented here, vasospasm and angina was shown by ergonovine without ST elevation. The patient was a 60-year-old man who presented with a 2-year history of frequent chest pain. There were no abnormalities in coronary angiography. When ergonovine (100 microg) was injected, total occlusion of the proximal right coronary artery was seen, without ST elevation at the electrocardiogram. The cause was collateral from left anterior descending artery to distal right coronary artery at the left coronary angiography. Therefore, in a patient with variant angina without ST elevation, a transient collateral circulation during vasospasm should be considered.
Angina Pectoris, Variant ; Arteries ; Chest Pain ; Collateral Circulation ; Coronary Angiography ; Coronary Vessels ; Electrocardiography ; Ergonovine ; Humans ; Middle Aged

BACKGROUND AND OBJECTIVES: The intracoronary injection of acetylcholine (Ach) has been shown to induce coronary spasms in patients with variant angina. Clinical significance and angiographic characteristics of patients with a significant response to lower Ach dosages are as-yet non-clarified compared with patients responding to higher Ach doses. SUBJECTS AND METHODS: A total of 3034 consecutive patients underwent coronary angiography with Ach provocation tests from January 2004 to August 2010. Ach was injected in incremental doses of 20, 50, 100 microg into the left coronary artery. Significant coronary artery spasm was defined as focal or diffuse severe transient luminal narrowing (>70%) with/without chest pain or ST-T change on the electrocardiogram (ECG). We compared the clinical and angiographic characteristics of patients who responded to a lower Ach dose (20 or 50 microg, n=556) to those that responded to a higher Ach dose (100 microg, n=860). RESULTS: The baseline clinical and procedural characteristics are well balanced between the two groups, except diabetes was higher in the lower Ach dose group and there were differences in medication history. After adjusting for confounding factors, the lower Ach dose group showed more frequent temporary ST elevation and atrioventricular block on the ECG. Furthermore, the group of patients who responded to the lower Ach dose was associated with a higher incidence of baseline and severe spasm than those who responded to a higher Ach dose. CONCLUSION: Patients with a significant response to a lower Ach dose were associated with more frequent ST elevation, baseline spasm, and more severe spasm compared with those who responded to a higher Ach dose, suggesting more intensive medical therapy with close clinical follow-up is required for those patients.
Acetylcholine ; Angina Pectoris, Variant ; Atrioventricular Block ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Electrocardiography ; Humans ; Incidence ; Phenobarbital ; Spasm

BACKGROUND AND OBJECTIVES: During coronary angiography and interventional procedures, catheters that are engaged in a coronary ostium are routinely flushed, typically with normal saline, to expel blood from the catheter or to inject a pharmacologic agent. Saline contains sodium and chloride ions. Such injections may affect the electrophysiologic properties of the myocardium; however, the effect of normal saline on ventricular repolarization has not been established in patients with variant angina. SUBJECTS AND METHODS: We studied 51 consecutive patients with variant angina. Five mL of normal saline (NS) or 5% dextrose solution (DW) were infused into the left coronary artery in random order. We measured the heart rate, QT interval, and T-wave amplitude using Mac-Lac 5.2. RESULTS: The baseline clinical characteristics were not different between the NS {n=30 (14 males); mean age, 56+/-10 years} and the 5% DW groups {n=21 (7 males); mean age, 59+/-10 years}. The changes in the mean corrected QT (QTc) interval were significantly increased at the time of infusion of NS compared to 5% DW (45.1+/-30.3 vs. 20.9+/-23.3 ms, p=0.004). There was a T-wave amplitude change >0.2 mV in at least one-lead in 27 patients (90.0%) during NS infusion compared to 7 patients (33.3%) during 5% DW infusions (p=0.001). No significant changes in heart rate and blood pressure were noted during of the infusions. CONCLUSION: NS was associated with prolongation of ventricular repolarization in patients with variant angina.
Angina Pectoris, Variant ; Angiography ; Blood Pressure ; Catheters ; Coronary Angiography ; Coronary Vessels ; Glucose ; Heart Rate ; Humans ; Ions ; Sodium ; Sodium Chloride

Ventricular septal defect (VSD) complicating an acute myocardial infarction is rather uncommon. However, the outcomes after the development of a VSD are poor with an in-hospital mortality of more than 90% for the medically treated patients. To prevent the recurrence of VSD, many techniques have been reported on for the closure of a postinfarction VSD. In this report, we present a case of a patient who had a postinfarction VSD due to Prinzmetal's variant angina, and the rupture of the pseudoaneurysm of the left ventricle was successfully treated by the "Sandwich technique"
Aneurysm, False ; Angina Pectoris, Variant ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Hospital Mortality ; Humans ; Myocardial Infarction ; Recurrence ; Rupture

OBJECTIVEThis study is aimed to compare the clinical characteristics of patients with typical and atypical coronary artery spasm.

METHODSOut of 64 patients with chest pain at rest and without significant coronary artery stenosis, coronary artery spasm was provoked by intracoronary injection of acetylcholine in 46 patients, including 12 with ST segment elevation (typical coronary artery spasm group) and 34 without ST segment elevation (atypical coronary artery spasm group). The demographic data, coronary angiographic findings, treadmill electrocardiogram, dipyridamole and rest thallium-201 myocardial perfusion computed tomography, and the follow-up clinical data of the two groups were compared.

RESULTSThe patients with typical coronary artery spasm were younger (47 +/- 6 vs. 58 +/- 12, P < 0.05) than patients with atypical coronary artery spasm group. Hyperlipidemia were more common in atypical coronary artery spasm group (74% vs. 33%, P < 0.05) and myocardial bridging was more common in patients with typical coronary artery spasm group (67% vs. 32%, P < 0.01). Focal coronary spasm during acetylcholine provocation was seen in 92% patients with typical coronary spasm and in 32% patients with a atypical coronary artery spasm (P < 0.01) while diffuse coronary spasm was seen in 8% patients with typical coronary spasm and in 68% patients with a atypical coronary artery spasm (P < 0.01). All patients with coronary artery spasm were treated with aspirin, calcium channel blockers, long-acting nitroglycerine, with or without lipid-lowering drugs, 2 patients with typical coronary spasm and 4 patients with atypical coronary spasm were rehospitalized due to chest pain and rest of the patients remained free of chest pain during the median follow-up period of 18 +/- 14 months.

CONCLUSIONAtypical coronary artery spasm is common in patients with rest angina and diffuse coronary microvascular spasm might be the cause of chest pain in these patients.

Acetylcholine ; Adult ; Angina Pectoris, Variant ; diagnosis ; Coronary Angiography ; Coronary Vasospasm ; diagnosis ; Electrocardiography ; Exercise Test ; Female ; Humans ; Male ; Middle Aged ; Prognosis