Case Of Vasospastic Angina Research Articles

Abstract 16001: Recurrent Vasospastic Angina Caused by Electronic Cigarette Usage

Introduction: A 45 year old female with a past medical history significant for tobacco use disorder presented for evaluation of substernal pressure with radiation to the left shoulder, nausea, and dizziness. There was no associated shortness of breath, diaphoresis, or palpitations. Her symptoms were not associated with exertion. Hypothesis: The differential diagnosis for this atypical chest pain included unstable angina, microvascular angina, vasospastic angina, Takotsubo syndrome, and anxiety. Methods: An ECG revealed ST-segment elevations in the inferior leads, and an emergent coronary angiography demonstrated no significant atherosclerotic disease. However, her right coronary artery was found to be in vasospasm. Nitroglycerin was administered and relieved her chest pain, and her ECG changes returned to baseline after the episode. This fulfilled COVADIS criteria, and a diagnosis of vasospastic angina was made. Results: The patient was treated with nitroglycerin and a calcium channel blocker. She stopped smoking cigarettes and symptoms did not recur. Five years later, the patient again presented with similar symptoms. She reported that she had recently started smoking electronic cigarettes. The patient was counseled to stop using electronic cigarettes. One month later, the patient reported no further episodes of chest pain. Conclusions: We report a case of vasospastic angina caused by electronic cigarette use. Cardiac toxicity from electronic cigarettes is believed to result from exposure to nicotine as well as other chemicals including synthetic vitamin E, aldehydes, and metals present in electronic cigarettes. Though the concentration of nicotine in the blood of electronic cigarette users is highly variable, some reports describe levels comparable to or higher than those in patients who use paper cigarettes. In this patient, cessation of electronic cigarette smoking was effective in eliminating symptoms of vasospastic angina.

Drug Coated Balloonによる労作性狭心症治療後に運動誘発性冠攣縮性狭心症を発症した1例

Drug Coated Balloonによる労作性狭心症治療後に運動誘発性冠攣縮性狭心症を発症した1例

P6005Incidence and clinical characteristics of coronary artery spasm in patients with out-of-hospital cardiac arrest

Abstract Background Substantial cases of out-of-hospital cardiac arrest (OHCA) due to acute coronary syndrome have been recognized thus far, but there have been few reports about the aetiology of patients with OHCA without the organic heart disease. Especially, coronary artery spasm would be one of the causes of OHCA. Purpose This study aimed to investigate causes of OHCA without the organic heart disease and to investigate the characteristics and angiographic findings of OHCA patients with vasospastic angina (VSA). Methods Between January 2010 and April 2018, 920 patients with OHCA caused by probable or definite cardiovascular disease were transferred to our hospital. Return of spontaneous contraction was successfully achieved in 151 patients, among whom diagnosis was made in 130 patients. First, we analysed the causes of OHCA in these patients. Second, we compared clinical and angiographic characteristics between the VSA group with OHCA (OHCA-VSA) and the VSA group without OHCA (stable VSA; n=72) from our database. Results Among the 130 patients, 95 (73%) had the organic heart disease; 72, acute coronary syndrome; 19, myocardial disease; 2, valvular heart disease; and 1, congenital heart disease. There were 35 patients (27%) without the organic heart disease. Nineteen patients had primary (i.e., Brugada syndrome, QT prolongation) or secondary arrhythmia (i.e. drug adverse effect). Electrocardiogram, coronary angiogram, and LV structure and function were normal in 35 patients. However, there were 16 patients (11%) with VSA defined by Japanese guideline. The OHCA-VSA group was significantly younger (50±14) than the stable VSA group (64±11, P=0.003). The incidence of diffuse-type spasm in the OHCA-VSA group (100%) was significantly higher than that in the stable VSA group (100% vs. 69%, P<0.05). In addition, the incidence of triple-vessel coronary spasm in the OHCA-VSA group was significantly higher than that in the stable VSA group (86% vs. 25%, P=0.003). Conclusion OHCA patients without the organic heart disease had considerable cases of VSA, in addition to primary or secondary arrhythmia. Furthermore, the severity of spasm in the OHCA-VSA group was more serious and extensive than in comparison with the stable VSA group.

Vasospastic angina and early repolarization induced polymorphic ventricular tachycardia – a chance For treatment success?

We describe a case of Vasospastic angina and early repolarisation syndrome, which induced polymorphic Ventricular tachycardia episodes. Surprisingly, the angina episodes dissapeared only after atrial arrhythmias treatment and percutaneous atrial fibrillation ablation.

A Case of Vasospastic Angina in the Detection of a High Signal Intensity Area by using Balanced SSFP with Inversion Recovery

Image evaluation for vasospastic angina frequently generally utilizes nuclear medicine or cardiac magnetic resonance CMR T weighted image by CMR particularly is a non invasive and simple evaluation method with some issues Those issues might often be an unclear boundary area for high signal intensity poor visualization due to myocardial saturationby arrhythmia and difficulty in evaluation In the present study we reported a case in the clear detection of a high signal intensity area compared to the existing T weighted image while concurrently utilizing ldquo InversionRecovery rdquo and ldquo Balanced SSFP steady state free precession rdquo as usable even with a general purpose equipment for solving the above mentioned issues nbsp

Three cases of vasospastic angina following catheter ablation of atrial fibrillation

Pulmonary vein isolation is an effective treatment for patients with atrial fibrillation (AF).Although vasospastic angina (VSA) is not a common complication after ablation of AF, we report 3 cases of VSA following ablation of persistent AF. Two of the 3 patients felt chest pain following pulmonary vein isolation, and complex fractionated atrial electrogram ablations were performed. ST elevation in the inferior leads and atrioventricular block occurred because of severe coronary vasospasm. In the third patient, the electrocardiography monitor detected transient ST elevation within an hour after ablation. Treatment of VSA may be required following catheter ablation of AF.

A case of vasospastic angina which developed ventricular fibrillation due to skipping medicine for a single day

A case of vasospastic angina which developed ventricular fibrillation due to skipping medicine for a single day

A case of vasospastic angina in which the ergonovine provocation test with intracoronary isosorbide dinitrate and nicorandil was effective in the diagnosis of microvascular spasm

A 60-year-old man was admitted with early morning angina while at rest. Coronary angiogram revealed no organic lesions; therefore, a spasm provocation test with ergonovine was performed. Administration of intracoronary ergonovine induced total occlusion of the right coronary artery. The induced total occlusion improved but coronary flow velocity remained severely reduced and chest discomfort with ST-T changes in ECG remained in spite of repeated administration of isosorbide dinitrate (ISDN). Intracoronary administration of nicorandil following ISDN alleviated the chest discomfort, normalized the ST-T change in ECG, and improved the coronary flow. This suggested that microvascular spasm and the epicardial spasm were not relieved by ISDN but by nicorandil. Intracoronary nicorandil injection following ISDN administration may be useful for the diagnosis of microvascular spasm in the ergonovine provocation test.

Two cases of vasospastic angina after second generation drug eluting stent implantation

Two cases of vasospastic angina after second generation drug eluting stent implantation

Three Cases of Vasospastic Angina that Developed Following the Initiation of Corticosteroid Therapy

Three patients diagnosed as having remitting seronegative symmetrical synovitis with pitting edema syndrome, pemphigus erythematosus and idiopathic interstitial pneumonia were treated with oral prednisolone. Several weeks after starting the treatment, they experienced repeated chest pain attacks between midnight and early morning, although none of the patients had a past history of ischemic heart disease. One of the patients exhibited aggravation of symptoms soon after increasing the dose of prednisolone. A definitive diagnosis of vasospastic angina was made using electrocardiograms, coronary angiography and vasospasm provocation tests. These cases emphasize that clinicians should be aware of the possible occurrence of vasospastic angina following the initiation of corticosteroid therapy.

<b>西洋薬による症状コントロール困難な冠攣縮性狭心症に対して四逆散と桂枝茯苓丸の併用が</b><b>有効であった2症例</b>

<b>西洋薬による症状コントロール困難な冠攣縮性狭心症に対して四逆散と桂枝茯苓丸の併用が</b><b>有効であった2症例</b>

症例 躁うつ病の病相に従って寛解,増悪を繰り返した冠攣縮性狭心症の1例

症例 躁うつ病の病相に従って寛解,増悪を繰り返した冠攣縮性狭心症の1例

A case of vasospastic angina with transient collateral flow detected by emergent coronary angiography during the attack

A case of vasospastic angina with transient collateral flow detected by emergent coronary angiography during the attack

Dihydroergotamine-Induced Vasospastic Angina in a Patient Taking a Calcium Channel Blocker

To report a probable case of vasospastic angina after administration of dihydroergotamine mesylate in a patient without coronary artery disease. A 49-year-old woman with relapsing/remitting multiple sclerosis was admitted for severe headache and pain crisis. She received a single dose of intravenous dihydroergotamine and, within 30 minutes, experienced chest pain, nausea, and vomiting. No changes on electrocardiogram were noted, but cardiac enzyme levels were elevated. Brief episodes of chest pain persisted for several days and resolved spontaneously before the woman's discharge. She had several cardiac risk factors, including cigarette smoking, hypertension, and a family history of coronary artery disease, but cardiac catheterization on hospital day 5 revealed no underlying coronary artery disease. Although cardiovascular adverse reactions have been reported with ergotamine tartrate, dihydroergotamine has rarely been linked with such reactions, including coronary vasospasm and myocardial infarction. Prescribing information for dihydroergotamine cautions against its use in patients with coronary artery disease or risk factors for underlying coronary artery disease without a cardiac workup before initiation of therapy. This patient had several cardiac risk factors, but cardiac catheterization revealed no underlying coronary artery disease. Concomitant verapamil therapy for hypertension did not prevent the vasospastic effects of dihydroergotamine. The Naranjo probability scale revealed a probable adverse reaction of vasospastic angina associated with dihydroergotamine. Health-care professionals should be aware of the possibility for vasospastic angina in patients receiving dihydroergotamine who have no underlying coronary artery disease. Prescribing information should be closely followed.

A case of vasospastic angina with Brugada-like electrocardiogram in coronary vasospasm test: A case report

A case of vasospastic angina with Brugada-like electrocardiogram in coronary vasospasm test: A case report

A case of vasospastic angina with repeated ventricular fibrillation

A case of vasospastic angina with repeated ventricular fibrillation

A case of vasospastic angina with syncope and clinical evidence consistent with Brugada syndrome

[in Japanese]

A case of vasospastic angina showing resolution of coronary vasospasm in acetylcholine provocation test corresponding to regression of coronary atherosclerosis

We experienced a case of vasospastic angina showing resolution of vasospasm in the acetylcholine provocation test corresponding to regression of coronary atherosclerotic plaque following treatment with a combination of benidipine and pravastatin.

A case of vasospastic angina with Brugada type ECG abnormalities

A case of vasospastic angina with Brugada type ECG abnormalities

A case of vasospastic angina with worsening of vasospasm during interferon therapy for chronic hepatitis C

A case of vasospastic angina with worsening of vasospasm during interferon therapy for chronic hepatitis C