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

Administration, Intravenous ; Angina Pectoris, Variant ; drug therapy ; Humans ; Male ; Middle Aged ; Solanaceous Alkaloids ; administration & dosage ; therapeutic use

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

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

BACKGROUNDSpontaneous attack of variant angina (VA) is a unique component of coronary artery disease (CAD), and associated with severe cardiac events. However, no data are available regarding sex differences in Chinese patients with spontaneous attacks of VA. Accordingly, the present retrospective study was initiated to evaluate the Clinical characteristics of Chinese female patients with spontaneous attacks of VA.

METHODSFrom January 2003 to January 2008, a total of 209 patients were diagnosed to have had a spontaneous attack of VA at Fu Wai Hospital. Of them, 27 were female, and their clinical findings were collected and compared with male patients for aspects of risk factors, clinical features and angiographical findings.

RESULTSSpontaneous attacks of VA was relatively uncommon in female (12.9%) compared with male patients. The female patients were less likely to have a history of smoking (14.8% vs. 79.7%, P < 0.001), more likely to have a family history of CAD (33.3% vs. 11.0%, P < 0.01), and to have had a greater incidence of ventricular fibrillation during attack (11.1% vs. 2.2%, P < 0.05). There were no significant differences in other characteristics between the two groups.

CONCLUSIONChinese female patients who experienced a spontaneous attack of VA had the characteristics of less smoking history, more family history of CAD and higher occurrence of ventricular fibrillation than male patients.

Adult ; Angina Pectoris, Variant ; pathology ; Asian Continental Ancestry Group ; Coronary Angiography ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Sex Factors