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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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[Coronary spasm a diagnostic and therapeutic challenge]. Presse Med 2018; 47:798-803. [PMID: 30245142 DOI: 10.1016/j.lpm.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/05/2018] [Accepted: 08/07/2018] [Indexed: 12/15/2022] Open
Abstract
Vasospastic angina is a clinical and physio-pathological entity, which has been documented for many years, but its diagnosis is under-estimated despite the fact that though inadequately considered and investigated. This condition is potentially serious and can sometimes trigger severe arrhythmia resulting in ventricular fibrillation and sudden death. This pathology has a higher incidence in Asia, where it is, therefore, better documented with provocative testing being carried out more frequently, while in France, these tests are not sufficiently performed probably due to the fact that they often produce negative findings. Provocative tests with Ergonovine injection should be performed via intra-coronary to improve its sensibility. Should this test become more sensitive and more routinely performed, this condition, which often responds well to medical treatment, could regain appropriate recognition as a coronary disease.
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Halna du Fretay X, Bouzid MA, Blanchard-Lemoine B, Benamer H. [Is coronary artery spasm a disease specific to women?]. Ann Cardiol Angeiol (Paris) 2016; 65:446-450. [PMID: 27817850 DOI: 10.1016/j.ancard.2016.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Vasospastic angina is considered rare in Europe but with a prevalence probably underestimated and affects preferentially men in published studies, mostly involving Asian populations. Vasospastic angina in the female population have specificities in terms of pathophysiology, clinical presentation and prognosis, as well as diagnostic strategies currently recommended, that we describe from a clinical case. Although known for over 50years, vasospastic angina remains a disease still insufficiently researched, probably even less in women. This form of angina must not however be forgotten, and the appropriate diagnostic strategy must be known and used to improve prognosis.
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Affiliation(s)
- X Halna du Fretay
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Centre hospitalier universitaire Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Centre d'exploration cardiovasculaire, 1, rue du Baron, 45000 Orléans, France.
| | - M A Bouzid
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - B Blanchard-Lemoine
- Centre d'exploration cardiovasculaire, 1, rue du Baron, 45000 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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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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