Variant angina pectoris (VAP) is a special type of unstable angina with coronary artery spasm as the main pathogenesis, characterized by resting chest pain, and transient ST segment dynamic changes. The development of acute myocardial infarction is not uncommon. We report a case of a 49-year-old female patient diagnosed with VAP at 2 years before who suddenly suffered severe chest pain. Troponin-I was elevated. Immediate coronary angiography showed near-total occlusion in the proximal left anterior descending artery, which was not fully dilated despite use of intracoronary nitroglycerin. Intravascular ultrasound showed focal significant stenosis with a large amount of plaque at the site of spasm and the lesion was successfully treated with drug-eluting stent placement. Intravascular imaging may be instrumental in high-risk patients with VAP who suffer recurrent chest pain despite intensive anti-spasm medications.
Angina Pectoris, Variant ; Angina, Unstable ; Arteries ; Atherosclerosis* ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Drug-Eluting Stents ; Female ; Humans ; Middle Aged ; Myocardial Infarction* ; Nitroglycerin ; Spasm* ; Troponin I ; Ultrasonics ; Ultrasonography

BACKGROUND: Although a laparoscopic cholecystectomy results in less pain than an open cholecystectomy, it is not a pain-free procedure. Therefore, this study was conducted to determine whether perioperative intravenous lidocaine would reduce postoperative pain after a laparoscopic cholecystectomy. METHODS: Fifty patients undergoing laparoscopic cholecystectomy were divided into two groups; a lidocaine group, in which patients were injected with a lidocaine bolus (1.5 mg/kg) and infusion (1.5 mg/kg/h); and a control group, in which patients were injected with the same volume of saline bolus and infusion. Intravenous lidocaine was initiated before anesthesia was administered and continued for 1 hour postoperatively. The intensity of abdominal and shoulder pain was then assessed 1, 6, 12 and 24 hours after surgery and recorded using a visual analog pain score (VAS) and verbal rating score (VRS). RESULTS: The abdominal pain score (VAS and VRS) was significantly lower in the lidocaine group than in the control group at all times evaluated during the first 24 hours after surgery (P < 0.05). In addition, the shoulder pain score and incidence were significantly lower in the lidocaine group than the control group at 12 hours and 24 hours after surgery (P < 0.05). In the lidocaine group, the incidences of epigastric, right flank, and back pain were lower than that of the control group, but these differences were not statistically significant. CONCLUSIONS: Perioperative intravenous lidocaine reduces shoulder and abdominal pain for 24 hours after laparoscopic cholecystectomy.
Abdominal Pain ; Anesthesia ; Back Pain ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Humans ; Incidence ; Lidocaine ; Oxalates ; Pain, Postoperative ; Shoulder ; Shoulder Pain

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

Left ventricular diverticulum is rare cardiac malformation;fewer than 30 cases have been reported in the world. We present a case of left ventricular diverticulum with chest pain suggested unstable angina. Myocardial rupture of this case was occured during cardiac catherization. patient was recovered and discharged. Relevant literature was also reviewed.
Angina, Unstable ; Chest Pain ; Diverticulum* ; Humans ; Rupture

OBJECTIVE: To investigate the frequency, nature and risk factors of musculoskeletal problems in pregnancy. METHOD: We obtained the information through a questionnaire and physical examination of full-term (gestational age over 38 weeks) pregnant women. Prevalence, onset time, severity and risk factors of musculoskeletal problems were analyzed. RESULTS: Among the 70 pregnant women, 37 women (53%) complained of low back pain which was the most common musculoskeletal problem in pregnancy. Other problems were hand symptoms (31%), lower extremity joint pain (31%), leg cramp (29%), chest pain, shoulder pain and neck pain. Previous history of low back pain was significantly correlated with the occurrence of low back pain in pregnancy. Weight gain during pregnancy and amount of time of housework during pregnancy were significantly correlated with carpal tunnel syndrome. Pregnant women suffering from leg cramp were significantly old in age. CONCLUSION: Prevalence of musculoskeletal problems during pregnancy was relatively high and several risk factors were related with occurrence of those problems. So, prophylactic risk factor control would be necessary to reduce musculoskeletal problems during pregnancy.
Arthralgia ; Carpal Tunnel Syndrome ; Chest Pain ; Female ; Hand ; Housekeeping ; Humans ; Leg ; Low Back Pain ; Lower Extremity ; Muscle Cramp ; Neck Pain ; Physical Examination ; Pregnancy* ; Pregnant Women ; Prevalence ; Surveys and Questionnaires ; Risk Factors ; Shoulder Pain ; Weight Gain

Unstable angina is a critical phase of coronary heart disease, with widely variable symptoms and prognoses. Recently, despite the advances in surgical revascularization, catheter-based revascularization and medical treatment, an increasing number of patients with angina pectoris are refractory to medical therapy and; therefore, can not be considered as candidates for coronary artery bypass grafting or interventional angioplasty. These patients are often treated with narcotics for pain relief, and forced to severely reduce their levels of activity and productivity. It has become clear that alleviating the pain caused by myocardial ischemia may be possible by altering the sympathetic afferent nerve fibers. Sympathetic blockade can be produced using high thoracic epidural analgesia. Herein, the case of a patient with intractable angina and poor ventricular function, who received high thoracic epidural analgesia to relieve ischemic chest pain, is reported.
Analgesia, Epidural* ; Angina Pectoris ; Angina, Unstable* ; Angioplasty ; Chest Pain ; Coronary Artery Bypass ; Coronary Disease ; Efficiency ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Narcotics ; Nerve Fibers ; Prognosis ; Ventricular Function

Study on 154 patients with chest pain, mean age: 61 years old, males accounted for 65%. Most common risk factors were hypertension 74%, high serum cholesterol level 60.4%, smoking 47.4%, diabetes 19.5%, family history 30.5%. B-mode ultrasonographic findings were normal carotid arteries in 22 patients (14.3%), intima-media thickness (IMT) >0.7 mm in 132 patients (85.7%), plaques of unilateral carotid arteries in 77 patients (50%), and plaques of bilateral carotid arteries in 36 patients (23.4%). There was a correlation between the IMT, the plaques of carotid arteries and the ages
Atherosclerosis, chest pain, angina pectoris

Ergonovine provocation test is known to be very sensitive for diagnosing variant angina. The patient described in this study initially presented with atypical chest pain and underwent coronary angiography and ergonovine provocation tests, which were negative. The patient was subsequently prescribed a proton pump inhibitor and prokinetics for pain relief, but then presented with acute myocardial infarction and cardiogenic shock due to coronary artery vasospasm 5 years later. This case suggests that ergonovine provocation test generates false negative results, which can lead to unwanted outcomes. Even with a negative ergonovine provocation test, prescription of calcium channel blockers or nitrates should be considered in patients with a clinical history suggestive of variant angina.
Angina Pectoris, Variant ; Calcium Channel Blockers ; Chest Pain ; Coronary Angiography ; Coronary Vasospasm ; Ergonovine ; Humans ; Myocardial Infarction ; Nitrates ; Prescriptions ; Proton Pump Inhibitors ; Shock, Cardiogenic

BACKGROUND AND OBJECTIVES: The therapeutic duration of variant angina is controversial. This study sought to determine the remission rates for coronary artery spasms, the factors associated with remission and the changes in spasm sites. SUBJECTS AND METHODS: Fifty-eight patients were enrolled in the study. Initial, and follow-up, coronary angiographies (CAG), with ergonovine stimulation tests, were performed. Paired CAG were performed at a mean interval of 27+/-17 months. Medication was stopped 3 days prior to the follow-up CAG, and the occurrence of chest pain during these 3 days was studied. Coronary spasms were confirmed by follow-up CAG. Any changes, and the diameters, of spasm sites were analyzed on each paired CAG. RESULTS: The remission rate of coronary spasms was 24% (14 patients), when the smoking group (49 patients) stopped smoking (31 patients), the remission rate was 29% (9 patients). In the current smoking group (18 patients), the remission rate was 6% (1 patient, p=0.05). 31 patients had chest pains after stopping medication prior to their follow-up CAG. Of those patients, 1 patient had a remission (3%). Among another 27 patients with no chest pain, 13 patients had a remission (48%, p<0.001). In 28 out of 44 patients (64%, non-remission), fluctuations in spastic locations were observed at the follow-up CAG. The interval changes in the diameter of the spasm sites were not significant. CONCLUSION: The non-chest pain group showed higher remission rates, but lack of chest pain did not identify the loss of coronary spasm. Atherosclerosis at spasm sites did not progress, as confirmed by the paired CAG in our study.
Angina Pectoris, Variant ; Atherosclerosis ; Chest Pain ; Coronary Angiography* ; Coronary Artery Disease ; Coronary Vessels ; Ergonovine ; Follow-Up Studies* ; Humans ; Muscle Spasticity ; Smoke ; Smoking ; Spasm*