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Nguyen TH, Ong GJ, Girolamo OC, De Menezes Caceres' V, Muminovic A, Chirkov YY, Horowitz JD. Angina due to coronary artery spasm (variant angina): diagnosis and intervention strategies. Expert Rev Cardiovasc Ther 2021; 19:917-927. [PMID: 34633245 DOI: 10.1080/14779072.2021.1991314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Since Prinzmetal first described a 'variant' form of angina pectoris, with predominantly resting episodes of pain and cyclic severity variations, it has gradually become apparent that this clinical presentation is caused by episodes of coronary artery spasm (CAS) involving focal or diffuse changes in large and/or small coronary arteries in the presence or absence of 'fixed' coronary artery stenoses. However, most clinicians have only limited understanding of this group of disorders. AREAS COVERED We examine the clinical presentation of CAS, associated pathologies outside the coronary vasculature, impediments to making the diagnosis, provocative diagnostic tests, available and emerging treatments, and the current understanding of pathogenesis. EXPERT OPINION CAS is often debilitating and substantially under-diagnosed and occur mainly in women. Many patients presenting with CAS crises have non-diagnostic ECGs and normal serum troponin concentrations, but CAS can be suspected on the basis of history and association with migraine, Raynaud's phenomenon and Kounis syndrome. Definitive diagnosis requires provocative testing at coronary angiography. Treatment still centers around the use of calcium antagonists, but with greater understanding of pathogenesis, new management options are emerging.
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Affiliation(s)
- Thanh Ha Nguyen
- Department of Cardiology, Central Adelaide Local Health Network, University of Adelaide, Basil Hetzel Institute for Translational Research, Adelaide, Australia
| | - Gao-Jing Ong
- Department of Cardiology, Central Adelaide Local Health Network, University of Adelaide, Basil Hetzel Institute for Translational Research, Adelaide, Australia
| | - Olivia C Girolamo
- Department of Cardiology, Central Adelaide Local Health Network, University of Adelaide, Basil Hetzel Institute for Translational Research, Adelaide, Australia
| | - Viviane De Menezes Caceres'
- Department of Cardiology, Central Adelaide Local Health Network, University of Adelaide, Basil Hetzel Institute for Translational Research, Adelaide, Australia
| | - Armin Muminovic
- Department of Cardiology, Central Adelaide Local Health Network, University of Adelaide, Basil Hetzel Institute for Translational Research, Adelaide, Australia
| | - Yuliy Y Chirkov
- Department of Cardiology, Central Adelaide Local Health Network, University of Adelaide, Basil Hetzel Institute for Translational Research, Adelaide, Australia
| | - John D Horowitz
- Department of Cardiology, Central Adelaide Local Health Network, University of Adelaide, Basil Hetzel Institute for Translational Research, Adelaide, Australia
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Kim M, Park JH, Lee JH, Sun BJ, Jin SA, Kim JH, Choi S, Jeong JO, Seong IW. Comparison of long-term clinical outcomes of percutaneous coronary intervention in vasospastic angina patients associated with significant coronary artery stenosis. Int J Cardiol 2016; 218:75-78. [PMID: 27232915 DOI: 10.1016/j.ijcard.2016.05.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 05/12/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Coronary spasm is the major pathophysiology of vasospastic angina (VA). Medical treatment is usually effective in VA patients without significant stenosis. However, there is little information about the percutaneous coronary intervention (PCI) in VA patients with significant coronary artery stenosis (CAS). METHODS After retrospective screening of all consecutive VA patients from January 2010 to April 2015, we selected significant CAS (>50% of diameter stenosis) after nitrate injection and divided them into two groups according to the presence of PCI. RESULTS A total of 220 VA patients (41 females, mean age: 58±10years old) were screened, and 85 were included in this study. Males were predominant in the VA with significant CAS group (89 vs 76%, p=0.020). PCI was done in 43 patients (51%). The most common culprit coronary artery was the left anterior descending coronary artery (18, 42%), diameter stenosis was significantly higher (66±9 vs 61±10%, p<0.01), and total number of antianginal medication was significantly lower in the PCI group than in the medical group (1.7±0.9 vs 2.1±0.8, p=0.039). Moreover, 4 patients underwent PCI to control symptoms in the medical treatment group during the follow-up period (26±13months). However, additional antiplatelet therapy was necessary in patients with coronary angioplasty, and there were 2 cases with complication associated with angioplasty (1 restenosis and 1 bleeding complication). CONCLUSION In VA patients with significant CAS, both treatment modalities showed similar clinical outcomes. Although the PCI can afford symptomatic improvement, it needed additional antiplatelet medications and can be associated with procedural complications.
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Affiliation(s)
- Mijoo Kim
- Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
| | - Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea.
| | - Jae-Hwan Lee
- Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
| | - Byung Joo Sun
- Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
| | - Seon Ah Jin
- Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
| | - Jun Hyung Kim
- Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
| | - SiWan Choi
- Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
| | - Jin-Ok Jeong
- Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
| | - In-Whan Seong
- Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
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Beltrame JF, Crea F, Kaski JC, Ogawa H, Ong P, Sechtem U, Shimokawa H, Bairey Merz CN. The Who, What, Why, When, How and Where of Vasospastic Angina. Circ J 2016; 80:289-298. [DOI: 10.1253/circj.cj-15-1202] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- John F. Beltrame
- The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network
| | - Filippo Crea
- Institute of Cardiology, Catholic University of the Sacred Heart
| | - Juan Carlos Kaski
- Cardiovascular and Cell Sciences Research Institute, St George’s, University of London
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Peter Ong
- Department of Cardiology, Robert-Bosch-Krankenhaus
| | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center
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Su YM, Gao SP, Ge LJ, Zhu JH, Pan M. Repeated syncope caused by intractable vasospastic angina: A case report. Int J Cardiol 2015; 185:269-74. [PMID: 25818538 DOI: 10.1016/j.ijcard.2015.03.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ya-Min Su
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, People's Republic of China
| | - Shu-Ping Gao
- Department of Cardiology, Ningxia People's Hospital, Yinchuan, People's Republic of China
| | - Li-Jun Ge
- Department of Cardiology, Ningxia People's Hospital, Yinchuan, People's Republic of China
| | - Jian-Hua Zhu
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, People's Republic of China
| | - Min Pan
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, People's Republic of China.
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Shin D, Lee MJ, Park CH, Kim J, Lee DS, Oh JH. Cardiogenic Shock in a Patient with Intermediate Coronary Artery Disease due to Preoperative Spasm. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.3.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Donghun Shin
- Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Korea
| | - Min-jin Lee
- Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Korea
| | - Chul-hong Park
- Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Korea
| | - Joongkeun Kim
- Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Korea
| | - Dae-sung Lee
- Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Korea
| | - Jun-Hyok Oh
- Department of Cardiology, Medical Research Institute, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Korea
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Walhout R, de Winter R, Simmers T, Buijs E. Aborted sudden cardiac death in a 52-yearold man without structural heart disease. Neth Heart J 2008; 16:239-41. [PMID: 18711609 PMCID: PMC2516285 DOI: 10.1007/bf03086153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Sudden cardiac death in the absence of apparent structural heart disease is an uncommon phenomenon. The majority of these patients do not have 'normal' hearts and specific diagnostic tools are required to identify structural or functional abnormalities. We describe the history of a 50-yearold man who survived ventricular fibrillation. Clinical investigation, including a coronary angiography and electrophysiological study, appeared to be normal. An implantable cardioverter defibrillator was inserted. Follow-up Holter monitoring was performed after a recurrent episode of ventricular tachycardia. It demonstrated transient ST-segment elevation. An acetylcholine provocation test was subsequently carried out. Reversible coronary spasm of the left descending coronary artery was found, during which a diagonal branch was occluded. It may be concluded that coronary spasm provocation is of value in the routine diagnostic work-up of patients surviving sudden cardiac death without apparent heart disease. (Neth Heart J 2008;16:239-41.).
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Affiliation(s)
- R.J. Walhout
- Department of Cardiology, Tergooi Hospitals, location Blaricum, the Netherlands
| | - R.J. de Winter
- Department of cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - T.A. Simmers
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands
| | - E.M. Buijs
- Department of Cardiology, Tergooi Hospitals, location Blaricum, the Netherlands
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Tacoy G, Kocaman SA, Balcioğlu S, Tanindi A, Ozdemir M, Cemri M, Cengel A. Coronary vasospastic crisis leading to cardiogenic shock and recurrent ventricular fibrillation in a patient with long-standing asthma. J Cardiol 2008; 52:300-4. [PMID: 19027611 DOI: 10.1016/j.jjcc.2008.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 05/26/2008] [Accepted: 05/28/2008] [Indexed: 11/19/2022]
Abstract
Acute myocardial infarction in patients with normal coronary arteries is a therapeutic dilemma. Coronary artery vasospasm and thrombosis are the most commonly encountered clinic problems and appear in localized coronary segments. The incidence of cardiovascular disease is increased in asthmatic patients. ß(2)-Adrenergic agonists use is associated with increased cardiovascular events. Although myocardial ischemia during asthma has been described in literature, acute myocardial infarction and ventricular fibrillation with normal coronary arteries in patients with asthma bronchiale is a rare entity. Our patient with long-standing asthma bronchiale presented with cardiogenic shock whose coronary angiography revealed multivessel disease and undergone primary percutaneous coronary intervention. Due to ongoing chest pain and hemodynamic instability; an early bypass surgery was planned. A control angiogram was performed before surgery. After intracoronary nitrate administration all narrowings in coronary vasculature disappeared. Symptom relief and clinical improvement was achieved with nitrate and calcium channel blockers later. After 2 months she was readmitted with cardiac arrest due to recurrent ventricular fibrillation and intracardiac defibrillator implantation was performed.
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Affiliation(s)
- Gulten Tacoy
- Gazi University, Faculty of Medicine, Cardiology Department, Besevler 06500, Ankara, Turkey.
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Teragawa H, Nishioka K, Higashi Y, Chayama K, Kihara Y. Treatment of Coronary Spastic Angina, Particularly Medically Refractory Coronary Spasm. Clin Med Cardiol 2008. [DOI: 10.4137/cmc.s681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hiroki Teragawa
- Department of Cardiovascular Medicine, Hiroshima, 734-8551, Japan
| | - Kenji Nishioka
- Department of Cardiovascular Medicine, Hiroshima, 734-8551, Japan
| | - Yukihito Higashi
- Department of Cardiovascular Physiology and Medicine, Hiroshima, 734-8551, Japan
| | - Kazuaki Chayama
- Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima, 734-8551, Japan
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Cho SH, Park IH, Jeong MH, Hwang SH, Yun NS, Hong SN, Lee SR, Kim KH, Moon JY, Hong YJ, Park HW, Kim JH, Ahn YK, Cho JG, Park JC, Kang JC. Increased Inflammatory Markers and Endothelial Dysfunction are Associated with Variant Angina. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.1.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sook Hee Cho
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - In Hyae Park
- College of Nursing of Chonnam National University, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
- Chonnam National University Research Institutute of Medical Sciences, Gwangju, Korea
| | - Seon Ho Hwang
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Nam Shik Yun
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Seo Na Hong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Sang Rok Lee
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Kye Hun Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jae Yun Moon
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Hyung Wook Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
- Chonnam National University Research Institutute of Medical Sciences, Gwangju, Korea
| | - Ju Han Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Young Keun Ahn
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
- Chonnam National University Research Institutute of Medical Sciences, Gwangju, Korea
| | - Jeong Gwan Cho
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
- Chonnam National University Research Institutute of Medical Sciences, Gwangju, Korea
| | - Jong Chun Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
- Chonnam National University Research Institutute of Medical Sciences, Gwangju, Korea
| | - Jung Chaee Kang
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
- Chonnam National University Research Institutute of Medical Sciences, Gwangju, Korea
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Kaku B, Ikeda M, Kato H, Takabatake S, Hayashi T, Taguchi T, Niita Y, Hiraiwa Y, Aoki S. Coronary Artery Multistenting in the Treatment of Life-Threatening Refractory Coronary Spasm After Coronary Artery Bypass Grafting. Int Heart J 2007; 48:379-85. [PMID: 17592202 DOI: 10.1536/ihj.48.379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 74-year-old man had undergone on-pump coronary artery bypass grafting (CABG) for effort-induced angina pectoris. Soon after CABG using the left internal thoracic artery for the left anterior descending artery and saphenous vein for the left circumflex artery, ST elevation was found in the inferior leads and complete atrioventricular block, ventricular tachycardia, and circulatory collapse occurred. Emergent coronary angiography revealed diffuse severe spasm of the right coronary artery (RCA). Despite the intravenous and intracoronary administration of massive doses of vasodilators and intra-aortic balloon pumping, the coronary spasm did not resolve. Five stents were deployed from the distal to the proximal portion of the RCA. After multistenting, coronary flow was dramatically improved and the ST elevations in the inferior leads were also improved. Coronary artery spasm after CABG is relatively rare, but when it occurs, it can be fatal. Multistenting is a useful treatment for life-threatening refractory coronary spasm after CABG.
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Affiliation(s)
- Bunji Kaku
- Division of Cardiovascular Medicine, Toyama Red Cross Hospital, Toyama
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Romagnoli E, Lanza GA. Acute myocardial infarction with normal coronary arteries: role of coronary artery spasm and arrhythmic complications. Int J Cardiol 2006; 117:3-5. [PMID: 17182140 DOI: 10.1016/j.ijcard.2006.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 10/21/2006] [Indexed: 11/17/2022]
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12
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Yun KH, Oh SK, Park EM, Kim HJ, Shin SH, Lee EM, Rhee SJ, Yoo NJ, Kim NH, Jeong JW, Jeong MH. An increased monocyte count predicts coronary artery spasm in patients with resting chest pain and insignificant coronary artery stenosis. Korean J Intern Med 2006; 21:97-102. [PMID: 16913438 PMCID: PMC3890744 DOI: 10.3904/kjim.2006.21.2.97] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Coronary atherosclerosis with inflammation gives rise to coronary vasospasm in the patients with coronary vasospastic angina. We have postulated that the peripheral leukocyte count and the differential count are associated with vasospastic angina. METHODS 144 patients who underwent intracoronary ergonovine provocation testing between January 2002 and December 2004 were divided into two groups: Group I (72 patients with provoked spasm, mean age: 54.8 +/- 10.7 years, males: 75%) and Group II (72 without spasm, mean age: 55.3 +/- 10.2 years, males: 35%). Blood sampling was done to measure the lipid profiles and inflammatory markers, including the high sensitive C-reactive protein (hsCRP) levels and the monocyte counts. We compared the angiographic findings and laboratory data between the two groups. RESULTS There were no significant differences in the levels of serum lipid and hsCRP between the two groups. The white blood cell count and the monocyte count were higher in Group I than with Group II (7496.4 +/- 2622.28 vs. 6703.2 +/- 1768.37/mm3, respectively, p = 0.035; 627.5 +/- 270.70 vs. 426.9 +/- 205.76/mm3, respectively, p < 0.001). Gensini's score was higher in Group I than in Group II (2.2 +/- 2.88 vs. 0.5 +/- 1.03, respectively, p < 0.001). Multivariate analysis showed that the monocyte count and Gensini's score were independent factors affecting coronary spasm (p = 0.047 and p = 0.018, respectively). According to a receiver operating characteristics curve analysis, the area under the curve of the monocyte count was 0.738, that of the neutrophil count was 0.577 and that of the WBC count was 0.572. The cut-off value of the monocyte count was 530/mm3; the sensitivity and specificity of this cut-off value were 64% and 76%, respectively. CONCLUSIONS The peripheral monocyte count is an independent marker for predicting vasospastic angina in the patients with resting chest pain and insignificant coronary artery stenosis.
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Affiliation(s)
- Kyeong Ho Yun
- Division of Cardiovascular Medicine, Wonkwang University School of Medicine, The Institute of Medical Sciences, Iksan, Korea
| | - Seok Kyu Oh
- Division of Cardiovascular Medicine, Wonkwang University School of Medicine, The Institute of Medical Sciences, Iksan, Korea
| | - Eun Mi Park
- Division of Cardiovascular Medicine, Wonkwang University School of Medicine, The Institute of Medical Sciences, Iksan, Korea
| | - Hyun Jung Kim
- Division of Cardiovascular Medicine, Wonkwang University School of Medicine, The Institute of Medical Sciences, Iksan, Korea
| | - Sung Hee Shin
- Division of Cardiovascular Medicine, Wonkwang University School of Medicine, The Institute of Medical Sciences, Iksan, Korea
| | - Eun Mi Lee
- Division of Cardiovascular Medicine, Wonkwang University School of Medicine, The Institute of Medical Sciences, Iksan, Korea
| | - Sang Jae Rhee
- Division of Cardiovascular Medicine, Wonkwang University School of Medicine, The Institute of Medical Sciences, Iksan, Korea
| | - Nam Jin Yoo
- Division of Cardiovascular Medicine, Wonkwang University School of Medicine, The Institute of Medical Sciences, Iksan, Korea
| | - Nam-Ho Kim
- Division of Cardiovascular Medicine, Wonkwang University School of Medicine, The Institute of Medical Sciences, Iksan, Korea
| | - Jin-Won Jeong
- Division of Cardiovascular Medicine, Wonkwang University School of Medicine, The Institute of Medical Sciences, Iksan, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
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Adlam D, Azeem T, Ali T, Gershlick A. Is there a role for provocation testing to diagnose coronary artery spasm? Int J Cardiol 2005; 102:1-7. [PMID: 15939093 DOI: 10.1016/j.ijcard.2004.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Accepted: 07/23/2004] [Indexed: 10/25/2022]
Abstract
Spontaneous coronary artery spasm is an important cause of morbidity both in patients with coronary artery disease and in those with variant angina. A number of pharmacological agents have been identified which can provoke coronary artery spasm in susceptible patients. The role of provocation testing in the clinical diagnosis of coronary spasm is controversial. This is reflected by variations in the clinical use of provocation testing between specialist cardiac centres. Provocation testing appears to be a sensitive method of identifying patients with variant angina and active disease but such patients can often be diagnosed clinically. The specificity is less clear. There is little evidence that altering patient therapy on the basis of a positive test modifies prognosis. There may be a role for provocation testing in rare patients with refractory disease to identify a target site for coronary stenting. A more widespread use of these tests in patients with undiagnosed chest pain syndromes would not currently be recommended.
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Affiliation(s)
- David Adlam
- Department of Cardiology, Glenfield Hospital, Groby Road, Leicester LE3 9QP, England.
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Nakamura R, Imamura T, Onitsuka H, Mishima K, Ishikawa T, Nagoshi T, Fujiura Y, Date H, Maeno M, Matsuo T, Koiwaya Y, Eto T. Interstitial pneumonia induced by ticlopidine. Circ J 2002; 66:773-6. [PMID: 12197605 DOI: 10.1253/circj.66.773] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 67-year-old female non-smoker, who had been diagnosed with familial hypercholesterolemia associated with severe atherosclerosis of the coronary, carotid and vertebral arteries, developed interstitial pneumonia 4 months after initiating ticlopidine to inhibit platelet aggregation. The lymphocyte stimulation test by ticlopidine was positive and bronchoalveolar lavage fluid showed an increase in lymphocytes and a decrease in the CD4+/8+ ratio, suggesting potentially undesirable side effects of ticlopidine. Two months after ticlopidine therapy was discontinued and prednisolone therapy started, the interstitial pneumonia had almost completely resolved. Two patients, one with ticlopidine-associated bronchiolitis obliterans organizing pneumonia and the other with pneumonia with multiple nodules, have been reported to date and the present patient is the third reported case of ticlopidine-induced pneumonia. The incidence of this side effect may not be so high because approximately 20 years have passed since ticlopidine was first marketed in Japan, but because the drug is now widely prescribed, this serious clinical side effect should be considered.
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Affiliation(s)
- Ryosai Nakamura
- First Department of Internal Medicine, Miyazaki Medical College, Kiyotake, Japan
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Tanabe Y, Itoh E, Suzuki K, Ito M, Hosaka Y, Nakagawa I, Kumakura M. Limited role of coronary angioplasty and stenting in coronary spastic angina with organic stenosis. J Am Coll Cardiol 2002; 39:1120-6. [PMID: 11923034 DOI: 10.1016/s0735-1097(02)01746-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We investigated the efficacy of percutaneous coronary intervention (PCI) in patients with coronary spastic angina (CSA) and severe organic stenosis. BACKGROUND Coronary spasm occurs at the site of organic stenosis in most patients with CSA and severe stenosis, whereas multivessel spasm occurs frequently in those with normal coronary arteries. The incidence of multivessel spasm and the efficacy of PCI in patients with CSA and severe stenosis have not been fully elucidated. METHODS Forty-five patients with CSA and severe stenosis underwent spasm provocative testing with intracoronary acetylcholine before and 7 +/- 3 months after PCI (20 patients had angioplasty and 25 patients had stenting), when all patients were free of restenosis. RESULTS Spasm was induced at the site of severe stenosis in 30 patients (66.7%) with (n = 12) or without (n = 18) spasm induced in another vessel. In the remaining 15 patients, spasm was induced at a different site in the stenotic vessel and/or in another vessel. Repeat provocative tests were performed in 43 of 45 patients. Although spasm was never induced at exactly the same site of the initial stenosis that had been dilated, spasm was induced at a different site in the dilated vessel and/or in another vessel, in 33 (76.7%) of 43 patients. Multivessel spasm occurred in 28 (62.2%) of 45 patients on one or both provocations. CONCLUSIONS Spasm was frequently induced at a site different from the initial stenosis, even in the absence of restenosis after PCI. Calcium antagonists should be continued in most patients with CSA who show no restenosis after PCI.
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Affiliation(s)
- Yasuhiko Tanabe
- Department of Cardiology, Niigata Prefectural Shibata Hospital, Shibata, Japan.
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