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Yang Y, Jiang X, Guo J, Zou K, Huang Q, Zhan B. Coronary artery spasm treated with intracoronary bioresorbable scaffold implantation under the guidance of treadmill test and optical coherence tomography: A case report. Ann Noninvasive Electrocardiol 2023; 28:e13037. [PMID: 36625433 DOI: 10.1111/anec.13037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Coronary artery spasm (CAS) can cause unstable angina, and the treatment of this disease is controversial. We report an elderly male patient who was admitted to hospital due to chest tightness. CAG showed that 70% stenosis in the middle of the right coronary artery (RCA). A bioresorbable scaffold (BRS) was implanted in the lesion under the guidance of optical coherence tomography (OCT). One year later, the patient's symptoms were relieved. The repeated CAG showed that the stent was good. BRS implantation under the guidance of treadmill test and OCT is one of treatment options for CAS patients.
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Affiliation(s)
- Yang Yang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xinghua Jiang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jun Guo
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kai Zou
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qianwei Huang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Biming Zhan
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Bhandari B, Kanderi T, Yarlagadda K, Qureshi M, Komanduri S. Coronary vasospasm as an etiology of recurrent ventricular fibrillation in the absence of coronary artery disease: a case report. J Community Hosp Intern Med Perspect 2021; 11:510-515. [PMID: 34211659 PMCID: PMC8221133 DOI: 10.1080/20009666.2021.1915534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Vasospastic angina (VA), or Prinzmetal’s angina, is characterized by symptoms of coronary angina caused by coronary vasospasm, usually in the absence of atherosclerotic changes. It typically presents with chest pain, which can be accompanied by transient electrocardiographic changes, if visualized during the attack. It can also rarely present with severe manifestations of acute myocardial angina, ventricular fibrillation, or cardiac arrest. Case presentation:
We present a case of a 50-year-old Caucasian male who initially presented to the hospital with chest pain and was diagnosed with VA. Later, he was brought to the hospital by emergency medical services later with ventricular fibrillation, despite normal coronary anatomy on angiogram. He was managed with placement of an intra–cardiac defibrillator (ICD) for secondary prevention. The patient continued to have recurrent episodes of ventricular fibrillation with associated ICD shocks, and had multiple admissions to the hospital with similar presentations. Symptoms and arrhythmia improved after optimizing antianginal therapy. Conclusions:
Ventricular fibrillation can be an uncommon but severe manifestation during VA crises. In cases with normal coronary vasculature, it is important to recognize VA as a cause of recurrent ventricular fibrillation in order to optimize medical management for prevention of fatal arrhythmias.
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Affiliation(s)
- Binita Bhandari
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, PA, USA
| | - Tejaswi Kanderi
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, PA, USA
| | - Keerthi Yarlagadda
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, PA, USA
| | - Mehreen Qureshi
- Department of Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle Cardiovascular Institute, Harrisburg, PA, USA
| | - Saketram Komanduri
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, PA, USA
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3
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Questionnaire in patients with aborted sudden cardiac death due to coronary spasm in Japan. Heart Vessels 2020; 35:1640-1649. [PMID: 32533313 DOI: 10.1007/s00380-020-01644-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/05/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES We investigated the medical or mechanical therapy, and the present knowledge of Japanese cardiologists about aborted sudden cardiac death (ASCD) due to coronary spasm. METHODS A questionnaire was developed regarding the number of cases of ASCD, implantable cardioverter-defibrillator (ICD), and medical therapy in ASCD patients due to coronary spasm. The questionnaire was sent to the Japanese general institutions at random in 204 cardiology hospitals. RESULTS The completed surveys were returned from 34 hospitals, giving a response rate of 16.7%. All SCD during the 5 years was observed in 5726 patients. SCD possibly due to coronary spasm was found in 808 patients (14.0%) and ASCD due to coronary spasm was observed in 169 patients (20.9%). In 169 patients with ASCD due to coronary spasm, one or two coronary vasodilators was administered in two-thirds of patients [113 patients (66.9%)], while more than 3 coronary vasodilators were found in 56 patients (33.1%). ICD was implanted in 117 patients with ASCD due to coronary spasm among these periods including 35 cases with subcutaneous ICD. Majority of cause of ASCD was ventricular fibrillation, whereas pulseless electrical activity was observed in 18 patients and complete atrioventricular block was recognized in 7 patients. Mean coronary vasodilator number in ASCD patients with ICD was significantly lower than that in those without ICD (2.1 ± 0.9 vs. 2.6 ± 1.0, p < 0.001). Although 16 institutions thought that the spasm provocation tests under the medications had some clinical usefulness of suppressing the next fatal arrhythmias, spasm provocation tests under the medication were performed in just 4 institutions. CONCLUSIONS In the real world, there was no fundamental strategy for patients with ASCD due to coronary spasm. Each institution has each strategy for these patients. Cardiologists should have the same strategy and the same knowledge about ASCD patients due to coronary spasm in the future.
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Sueda S, Sakaue T, Okura T. Spasm Provocation Tests under Medication May Help Decide on Medical or Mechanical Therapy in Patients with Aborted Sudden Cardiac Death due to Coronary Spasm. Intern Med 2020; 59:1351-1359. [PMID: 32132336 PMCID: PMC7332636 DOI: 10.2169/internalmedicine.4158-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The decision to perform medical or mechanical therapy in patients with aborted sudden cardiac death (ASCD) due to coronary spasm is controversial. The Japanese Circulation Society guidelines for the diagnosis and treatment of patients with coronary spastic angina mentioned that implantable cardioverter-defibrillator (ICD) is one option in patients with ASCD due to coronary spasm. We investigated the usefulness of spasm provocation tests under medications in five patients with ASCD due to coronary spasm. Methods We performed the spasm provocation tests under medications in five ASCD patients due to coronary spasm. Pharmacological spasm provocation tests, including five acetylcholine (ACh) tests, two ergonovine (ER) tests, and two ACh added after ER tests, were performed to estimate the effect of medications to suppressing the next fatal spasms. Results ACh tests under medications did not provoke spasm in one patient but did provoke in two patients. In the remaining two patients, neither the ACh test nor the ER test provoked spasm, but the ACh added after ER test induced a focal spasm in one coronary artery. We increased the medication dosage in four patients. An ICD was implanted in two patients, including one with refractory spasm and one with left main trunk spasm. One patient died due to pulseless electrical activity without ventricular fibrillation, while the remaining four patients survived. Conclusion Spasm provocation tests under medication in patients with ASCD due to coronary spasm may be an option when deciding on medical or mechanical therapy.
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Affiliation(s)
- Shozo Sueda
- Department of Cardiology, Ehime Prefectural Niihama Hospital, Japan
| | - Tomoki Sakaue
- Department of Cardiology, Ehime Prefectural Niihama Hospital, Japan
| | - Takafumi Okura
- Department of Cardiology, Ehime Prefectural Niihama Hospital, Japan
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5
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Geltser BI, Tsivanyuk MM, Kotelnikov VN, Karpov RS. Vasospastic angina: pathophysiology and clinical significance. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-1-2391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The review discusses an analysis of the literature on various aspects of the pathogenesis, diagnosis and treatment of vasospastic angina (VA). Data on the prevalence of coronary artery spasm (CAS) in various populations, as well as risk factors and triggers, are presented. We considered pathophysiological mechanisms of CAS, including hyperreactivity of coronary smooth muscle cells, endothelial dysfunction, nonspecific inflammation, oxidative stress, magnesium deficiency, autonomic imbalance, etc. The relationship of CAS with coronary atherosclerosis and thrombosis is emphasized. Modern recommendations for the diagnosis and treatment of VA are presented. Invasive verification of CAS is performed by pharmacological provocation tests with certain contraindications. Calcium antagonists and their combination with long-acting nitrates play a key role in the treatment of VA. Medications with a prospect for use in VA are Rho-kinase inhibitors, ATP-sensitive potassium channel activators, alpha-1 blockers. The management of patients with refractory VA and the prospects for endovascular treatment are discussed. It was noted that patients with multi-vessel VA are more likely to develop life-threatening arrhythmias and sudden death.
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Affiliation(s)
| | - M. M. Tsivanyuk
- Far Eastern Federal University; Vladivostok clinical hospital №1
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Ozdemir D, Kishor J, Hall JM, Chadow H, Rafii SE. A Rare Case of Vasospastic Angina Presenting with Inferior Lead ST-segment Elevation and Ventricular Fibrillation in the Absence of Coronary Obstruction: A Case Report. Cureus 2019; 11:e6332. [PMID: 31942263 PMCID: PMC6959840 DOI: 10.7759/cureus.6332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Vasospastic angina (VSA) is a variant form of angina pectoris, which occurs at night or at rest, with transient electrocardiogram modifications and preserved exercise capacity. Its association with stable angina, sudden cardiac death, acute coronary syndrome, arrhythmia, and syncope has previously been established. Its presentation can occur with or without existing coronary artery disease and may present with focal or diffuse alteration and dysfunction of the coronary vasculature. VSA diagnosis involves patient response to nitrates, transient ischemic electrocardiogram (ECG) changes, and coronary artery spasms. The mechanisms proposed to constitute the substrate for susceptibility to VSA include vascular smooth muscle cell hyperreactivity, endothelial dysfunction, magnesium deficiency, low-grade inflammation, altered autonomic nervous system response, hypothyroidism, and oxidative stress. Herein, we present the rare case of a patient with ST-segment elevation in the inferior leads, increased troponin, and an episode of ventricular fibrillation initially thought to be due to lateral wall ST-elevation myocardial infarction (STEMI), although it was revealed to be vasospastic angina. We will also review the literature. Vasospastic angina remains underdiagnosed and a timely diagnosis is crucial to prevent major cardiac events. In patients with diffuse ST-segment elevation on ECG (independently of angiographic findings), VSA should be considered as one of the differential diagnoses and treated if found to be the cause of pathological changes.
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Affiliation(s)
- Derman Ozdemir
- Internal Medicine, Saba University School of Medicine, Saba, NLD
| | - Joshi Kishor
- Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Julia M Hall
- Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Hal Chadow
- Cardiology, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Shahrokh E Rafii
- Cardiology, Brookdale University Hospital and Medical Center, Brooklyn, USA
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7
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Shklovskiy BL, Prokhorchik AA, Pyr'ev AN, Baksheev VI. [Prinzmetal angina. Questions of pathogenesis, clinic, diagnosis and treatment]. TERAPEVT ARKH 2019; 91:116-123. [PMID: 32598622 DOI: 10.26442/00403660.2019.11.000107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
Current problems of Prinzmetal angina (vasospastic angina, variant angina) considers in this review. Attention is drawn to early diagnosis, which should be comprehensive, taking into account possible atypical courses and the development of complications. The important role of electrocardiographic monitoring (including using implantable recorders) is highlighted. It is emphasized that patients with cardiac arrhythmias, syncope are at high risk of developing sudden cardiac death. In this category of patients, it is recommended to timely determine the indications for implantation of a cardioverter - defibrillator. Authors consider the prospects of using new methods of treatment of angina pectoris.
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Affiliation(s)
| | | | - A N Pyr'ev
- Vishnevsky 3 Central Military Clinical Hospital
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8
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Cherif G, Georges JL, Convers R, De Malherbe M, Ajlani B, Dagher Hayeck Y, Larnier L, Blicq E, Charbonnel C, Legriel S, Hervé D, Livarek B. [Coronary artery spasm revealed by an out-of-hospital cardiac arrest associated with a moyamoya disease. A case report of multimodality imaging]. Ann Cardiol Angeiol (Paris) 2019; 68:375-381. [PMID: 31471042 DOI: 10.1016/j.ancard.2019.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 06/10/2023]
Abstract
Moyamoya disease is a rare angiopathy characterized by a progressive distal occlusion of the internal carotid arteries and their branches. Extracerebral involvement, including coronary arteries, has been described. We report the case of a patient with moyamoya disease who suffered an out-of-hospital cardiac arrest associated with coronary spasm. We discussed the possible links between coronary spasm and moyamoya, as well as the contribution of multimodal cardiac imaging, combining conventional and intracoronary imaging, cardiac MRI, provocative tests for spasm, in the exploration of out-of-hospital cardiac arrest without obvious electrocardiographic and angiographic cause.
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Affiliation(s)
- G Cherif
- Service de cardiologie, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - J L Georges
- Service de cardiologie, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
| | - R Convers
- Service de cardiologie, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - M De Malherbe
- Service de radiologie, hôpital André-Mignot, centre hospitalier de Versailles, 78150 Le Chesnay, France
| | - B Ajlani
- Service de cardiologie, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Y Dagher Hayeck
- Service de cardiologie, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France; Service de rythmologie, institut de cardiologie, hôpital universitaire de la Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - L Larnier
- Service de cardiologie, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France; Service de rythmologie, institut de cardiologie, hôpital universitaire de la Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - E Blicq
- Service de cardiologie, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - C Charbonnel
- Service de cardiologie, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - S Legriel
- Service de réanimation médicale, hôpital André-Mignot, centre hospitalier de Versailles, 78150 Le Chesnay, France
| | - D Hervé
- Service de neurologie, groupe hospitalier Saint-Louis-Lariboisière Fernand-Widal, Assistance publique-Hôpitaux de Paris, 78018 Paris, France
| | - B Livarek
- Service de cardiologie, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
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9
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Benamer H, Saighi Bouaouina M, Masri A, Sarkis G, El Beze N, Millien V. [Vasospastic angina: An under-diagnosed pathology]. Ann Cardiol Angeiol (Paris) 2019; 68:341-346. [PMID: 31542201 DOI: 10.1016/j.ancard.2019.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/28/2019] [Indexed: 12/31/2022]
Abstract
The clinical and physiopathological clinical entity known as spastic angina or variant angina has been long documented. It remains, however, an under-estimated condition, which is insufficiently diagnosed and explored. This pathology is associated with severe complications such as heart rhythm disorders, which may potentially result in ventricular fibrillation and cause sudden death. In Japan, this condition occurs more frequently and is better documented. Stimulation tests are also carried out more often and have a higher positivity rate than in France where vasospastic angina is less frequently reported and where provocation tests are associated with negative results and are, consequently, performed less often. In order to improve the detection of this pathology, its potential presence should be explored in patients with rest angina who experience chest pain in the second half of the night and also in instances of acute coronary syndrome with sudden death and no angiographically visible coronary artery disease. The diagnosis should be confirmed by means of ergonovine provocation tests. In order to enhance the sensitivity of these tests without increasing the risk of complications, injection of ergonovine should be preferably carried out via the intracoronary route. By increasing the frequency and sensitivity of these tests, this pathology, which responds well to medical treatment in many cases, could be amenable to therapeutic management as any other form of coronary artery disease.
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Affiliation(s)
- H Benamer
- Groupe Ramsay générale de santé, Institut Jacques-Cartier, 6, avenue du Noyer-Lambert, 91300 Massy, France; ICVGVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - M Saighi Bouaouina
- Groupe Ramsay générale de santé, Institut Jacques-Cartier, 6, avenue du Noyer-Lambert, 91300 Massy, France; ICVGVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - A Masri
- ICVGVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - G Sarkis
- ICVGVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - N El Beze
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - V Millien
- Centre hospitalier Saint-Quentin, 1, rue Michel de l'Hôpital, 02100 Saint-Quentin, France
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10
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Gök G, Çinar T. Unexpected complications of vasospastic coronary artery disease and its successful management. J Cardiovasc Thorac Res 2019; 11:164-166. [PMID: 31384413 PMCID: PMC6669425 DOI: 10.15171/jcvtr.2019.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 05/10/2019] [Indexed: 11/24/2022] Open
Abstract
Vasospastic coronary artery disease (CAD) usually occurs during the percutaneous interventions and responds to conventional medical treatment. However, in rare conditions, it may be resistant to medical treatment, resulting in lethal complications, including acute myocardial infarction, ventricular arrhythmia, cardiopulmonary arrest, cardiogenic shock, and acute pulmonary edema. In this case report, a 44-year-old woman was admitted to the hospital with a diagnosis of non-ST-segment elevation myocardial infarction. During a diagnostic coronary angiography and in-hospital stays, multiple catastrophic complications due to vasospastic CAD occurred, and we were able to demonstrate a successful management strategy of these complications.
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Affiliation(s)
- Gülay Gök
- Medipol University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Tufan Çinar
- Health Science University, Sultan Abdülhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
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11
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Sueda S, Fujimoto K, Sasaki Y, Habara H, Kohno H. Cardiogenic Shock due to Pulseless Electrical Activity Arrest Associated with Severe Coronary Artery Spasm. Intern Med 2018; 57:2853-2857. [PMID: 29780109 PMCID: PMC6207832 DOI: 10.2169/internalmedicine.0196-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 75-year-old man was admitted to our hospital for follow-up coronary angiography. Just after starting coronary angiography, his electrocardiogram showed ST-segment elevation in the V1-6, I, II, and aVF leads, and he fell into catastrophic cardiogenic shock. His left coronary arteriogram showed proximal total obstruction in the left anterior descending artery and proximal subtotal occlusion in the left circumflex artery. Because pulseless electrical activity arrest was recognized, cardiopulmonary support was started. After more than 15 minutes' cardiac massage, his blood pressure gradually returned to baseline. During the cardiogenic shock due to pulseless electrical activity arrest, neither ventricular fibrillation nor ventricular tachycardia was recognized.
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Affiliation(s)
- Shozo Sueda
- Department of Cardiology, Ehime Niihama Prefectural Hospital, Japan
| | - Kaori Fujimoto
- Department of Cardiology, Ehime Niihama Prefectural Hospital, Japan
| | - Yasuhiro Sasaki
- Department of Cardiology, Ehime Niihama Prefectural Hospital, Japan
| | - Hirokazu Habara
- Department of Cardiology, Ehime Niihama Prefectural Hospital, Japan
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12
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Picard F, Sayah N, Spagnoli V, Adjedj J, Varenne O. Vasospastic angina: A literature review of current evidence. Arch Cardiovasc Dis 2018; 112:44-55. [PMID: 30197243 DOI: 10.1016/j.acvd.2018.08.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 02/08/2023]
Abstract
Vasospastic angina (VSA) is a variant form of angina pectoris, in which angina occurs at rest, with transient electrocardiogram modifications and preserved exercise capacity. VSA can be involved in many clinical scenarios, such as stable angina, sudden cardiac death, acute coronary syndrome, arrhythmia or syncope. Coronary vasospasm is a heterogeneous phenomenon that can occur in patients with or without coronary atherosclerosis, can be focal or diffuse, and can affect epicardial or microvasculature coronary arteries. This disease remains underdiagnosed, and provocative tests are rarely performed. VSA diagnosis involves three considerations: classical clinical manifestations of VSA; documentation of myocardial ischaemia during spontaneous episodes; and demonstration of coronary artery spasm. The gold standard diagnostic approach uses invasive coronary angiography to directly image coronary spasm using acetylcholine, ergonovine or methylergonovine as the provocative stimulus. Lifestyle changes, avoidance of vasospastic agents and pharmacotherapy, such as calcium channel blockers, nitrates, statins, aspirin, alpha1-adrenergic receptor antagonists, rho-kinase inhibitors or nicorandil, could be proposed to patients with VSA. This review discusses the pathophysiology, clinical spectrum and management of VSA for clinicians, as well as diagnostic criteria and the provocative tests available for use by interventional cardiologists.
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Affiliation(s)
- Fabien Picard
- Cardiology department, hôpital Cochin, AP-HP, 75014 Paris, France; Faculté de médecine, université Paris Descartes, 75006 Paris, France.
| | - Neila Sayah
- Cardiology department, hôpital Cochin, AP-HP, 75014 Paris, France
| | - Vincent Spagnoli
- Cardiology department, centre hospitalier affilié universitaire régional (CHAUR) de Trois-Rivières, QC G8Z 3R9 Tois-Rivières, Canada
| | - Julien Adjedj
- Cardiology department, centre hospitalier universitaire Vaudois, 1011 Lausanne, Switzerland
| | - Olivier Varenne
- Cardiology department, hôpital Cochin, AP-HP, 75014 Paris, France; Faculté de médecine, université Paris Descartes, 75006 Paris, France
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13
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Sueda S, Kohno H. Optimal Medications and Appropriate Implantable Cardioverter-defibrillator Shocks in Aborted Sudden Cardiac Death Due to Coronary Spasm. Intern Med 2018; 57:1361-1369. [PMID: 29321418 PMCID: PMC5995710 DOI: 10.2169/internalmedicine.8796-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Life-threatening ventricular arrhythmias are recognized in patients with coronary spastic angina. Implantable cardioverter-defibrillators (ICDs) are effective in patients with structural heart disease and ventricular fibrillation. However, the optimal medication for patients with aborted sudden cardiac death (SCD) due to coronary artery spasm after the implantation of ICD remains controversial. Methods We investigated the medications and the numbers of appropriate ICD shocks in 137 patients with a history of aborted SCD due to coronary spasm. Results Appropriate ICD shocks were observed in 24.1% (33/137) of patients with aborted SCD due to coronary spasm during 41 months of follow-up. Only 15 (15.6%) of the 96 patients with ICDs received aggressive medical therapy, including two or three calcium-channel antagonists. The rate of appropriate ICD shocks was significantly higher in Western countries than in Asian countries (42.9% vs. 19.3%, p<0.01), whereas the medications did not differ between the two regions. Appropriate ICD shocks successfully resuscitated 33 patients. Three patients died due to second serious fatal arrhythmias. Conclusion Appropriate ICD shocks were recognized in a quarter of patients with aborted SCD due to coronary spasm and ICD implantation was effective for suppressing the next serious fatal arrhythmia in these patients. We should reconsider prescribing more medications after ICD implantation in patients with aborted SCD due to coronary artery spasm.
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Affiliation(s)
- Shozo Sueda
- Department of Cardiology, Ehime Prefectural Niihama Hospital, Japan
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14
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Prognosis of Variant Angina Manifesting as Aborted Sudden Cardiac Death. J Am Coll Cardiol 2017; 68:137-45. [PMID: 27386766 DOI: 10.1016/j.jacc.2016.04.050] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 03/31/2016] [Accepted: 04/12/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The long-term prognosis of patients with variant angina presenting with aborted sudden cardiac death (ASCD) is unknown. OBJECTIVES The purpose of this study was to evaluate the long-term mortality and ventricular tachyarrhythmic events of variant angina with and without ASCD. METHODS Between March 1996 and September 2014, 188 patients with variant angina with ASCD and 1,844 patients with variant angina without ASCD were retrospectively enrolled from 13 heart centers in South Korea. The primary endpoint was cardiac death. RESULTS Predictors of ASCD manifestation included age (odd ratio [OR]: 0.980 by 1 year increase; 95% confidence interval [CI]: 0.96 to 1.00; p = 0.013), hypertension (OR: 0.51; 95% CI: 0.37 to 0.70; p < 0.001), hyperlipidemia (OR: 0.38; 95% CI: 0.25 to 0.58; p < 0.001), family history of sudden cardiac death (OR: 3.67; 95% CI: 1.27 to 10.6; p = 0.016), multivessel spasm (OR: 2.06; 95% CI: 1.33 to 3.19; p = 0.001), and left anterior descending artery spasm (OR: 1.40; 95% CI: 1.02 to 1.92; p = 0.04). Over a median follow-up of 7.5 years, the incidence of cardiac death was significantly higher in ASCD patients (24.1 per 1,000 patient-years vs. 2.7 per 1,000 patient-years; adjusted hazard ratio [HR]: 7.26; 95% CI: 4.21 to 12.5; p < 0.001). Death from any cause also occurred more frequently in ASCD patients (27.5 per 1,000 patient-years vs. 9.6 per 1,000 patient-years; adjusted HR: 3.00; 95% CI: 1.92 to 4.67; p < 0.001). The incidence rate of recurrent ventricular tachyarrhythmia in ASCD patients was 32.4 per 1,000 patient-years, and the composite of cardiac death and ventricular tachyarrhythmia was 44.9 per 1,000 patient-years. A total of 24 ASCD patients received implantable cardioverter-defibrillators (ICDs). There was a nonsignificant trend of a lower rate of cardiac death in patients with ICDs than those without ICDs (p = 0.15). CONCLUSIONS The prognosis of patients with variant angina with ASCD was worse than other patients with variant angina. In addition, our findings supported ICDs in these high-risk patients as a secondary prevention because current multiple vasodilator therapy appeared to be less optimal.
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Polytarchou K, Vouliotis AI, Kappos K, Manolis AS. Primary prevention of sudden cardiac death in Prinzmetal angina: The role of electrophysiology study in risk stratification. Hellenic J Cardiol 2016; 57:205-209. [DOI: 10.1016/j.hjc.2016.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 04/08/2016] [Indexed: 01/22/2023] Open
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Halna du Fretay X, Dibon O, Naël J. [Acute coronary syndromes with ST elevation and angiographically normal culprit coronary arteries: Case report and update]. Ann Cardiol Angeiol (Paris) 2015; 64:505-12. [PMID: 26525680 DOI: 10.1016/j.ancard.2015.09.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute coronary syndrome results in most cases of atherosclerotic plaque rupture. In a few cases, the physiopathological mechanism is different. This does not necessarily change the initial strategy but the subsequent treatments. We report three cases of clinical presentations of acute coronary syndrome whose pathophysiological mechanism is not or not mainly due to atherosclerotic lesions. Based on these cases and a review of the literature, two topics will be tackled: the diagnostic and therapeutic strategy in the management of Tako-tsubo cardiomyopathies and also acute coronary syndromes due to vasospastic angina.
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Affiliation(s)
- X Halna du Fretay
- Service de cardiologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Service de cardiologie, centre hospitalier universitaire Bichat - Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Service de cardiologie, centre hospitalier régional d'Orléans, 14, avenue de l'Hôpital, 45067 Orléans, France.
| | - O Dibon
- Service de cardiologie, centre hospitalier régional d'Orléans, 14, avenue de l'Hôpital, 45067 Orléans, France
| | - J Naël
- Service de cardiologie, centre hospitalier régional d'Orléans, 14, avenue de l'Hôpital, 45067 Orléans, France
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Halna du Fretay X, Mohammed Saeed D, Benamer H. [Diagnosis and treatment of spastic angina revealed by cardiac arrest]. Ann Cardiol Angeiol (Paris) 2014; 63:465-470. [PMID: 25450997 DOI: 10.1016/j.ancard.2014.09.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The prevalence of vasospastic angina is said to be low in Europe, but maybe because of a lack of diagnosis in the daily practice. However, coronary spasm is a common cause of cardiac arrest, especially among patients free of cardiac illness, and it should be systematically investigated after an unexplained cardiac arrest. Intracoronary spasm provocation test exposes patients to a lower risk compared to the risk of spontaneous spastic angina. Accurate modalities and diagnostic criteria have to be clarified for European population. Avoiding external causes of coronary spasm (such as cigarette smoking or more generally consuming coronary spasm inducing drugs) and prescribing antispastic medicine (first of all calcium channel blockers) are the basis of vasospastic angina treatment. However, recurrent coronary spasms have been reported despite an appropriate treatment and implantable automatic defibrillator has been implanted after case discussion when the onset of illness was cardiac arrest. We report the case of a patient recovering from cardiac arrest who had a positive spasm coronary provocation test, and was treated with calcium channel blockers and had been an automatic defibrillator implanted, with a coronary spasm provocation test performed afterward still contentious. While discussing this case, we are making a literature review of the diagnosis and treatment of spastic angina revealed by cardiac arrest.
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Affiliation(s)
- X Halna du Fretay
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; CHU Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Centre hospitalier régional d'Orléans, 14, avenue de l'Hôpital, 45067 Orléans, France.
| | | | - H Benamer
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Institut cardiovasculaire Paris Sud, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital européen de Paris-la-Roseraie, 120, avenue de la République, 93300 Aubervilliers, France
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Eschalier R, Motreff P, Bordachar P. Risk of recurrence after life-threatening ventricular arrhythmias in coronary spasm. Arch Cardiovasc Dis 2014; 107:205-6. [PMID: 24709284 DOI: 10.1016/j.acvd.2014.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 02/12/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Romain Eschalier
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Cardio-Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France.
| | - Pascal Motreff
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Cardio-Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
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