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Rafie N, Matchett CL, Jentzer JC. 38-Year-Old Woman With Chest Pain. Mayo Clin Proc 2023; 98:187-192. [PMID: 36603947 DOI: 10.1016/j.mayocp.2022.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Nikita Rafie
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Caroline L Matchett
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Jacob C Jentzer
- Advisor to residents and Consultant in Cardiovascular Medicine and Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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Pendela VS, Kudaravalli P, Chhabria M, Balmer-Swain M. ST segment elevation in an adult chest pain patient: A case of coronary artery vasospasm. Am J Emerg Med 2020; 38:1699.e1-1699.e3. [PMID: 32402497 DOI: 10.1016/j.ajem.2020.04.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 11/26/2022] Open
Abstract
Chest pain is one of the most common symptoms of patients presenting to the emergency department (ED) in the United States, accounting for up to eight million cases annually. We present a 55-year-old male who was brought in to the ED with sudden onset chest pain and was found to have ST-segment elevations in the infero-lateral leads on electrocardiogram (ECG). These changes resolved with nitroglycerin. Coronary artery vasospasm was diagnosed as coronary angiogram was normal. Calcium channel blocker was prescribed with good symptom relief. The most important teaching point is, coronary vasospasm as a cause of ST-segment elevation is missed frequently and should be considered among the differentials in patients presenting with chest pain. Nitrates and/or calcium channel blockers along with avoidance of triggers can help in symptom management.
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Affiliation(s)
- Venkata Satish Pendela
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, United States of America.
| | - Pujitha Kudaravalli
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, United States of America
| | - Mamta Chhabria
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, United States of America
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Ostovan MA, Khanian MS, Hamidi S, Fattahi M, Dehghani P. Spontaneous multi-focal coronary artery spasm: a case report. J Cardiovasc Thorac Res 2016; 8:137-139. [PMID: 27777700 PMCID: PMC5075363 DOI: 10.15171/jcvtr.2016.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/07/2016] [Indexed: 11/25/2022] Open
Abstract
Spontaneous coronary artery vasospasm is one of the important causes of acute chest pain syndromes. The diagnosis of diffuse multifocal spasm can be quite challenging and it could be easily mistaken for diffuse coronary artery disease. The use of intracoronary nitroglycerin can relieve spasm and reveal the real extent of coronary artery disease. Herein we present a case presenting with acute myocardial infarction due to severe coronary artery spasm that had even received fibrinolytic therapy. Multiple narrowing was shown during coronary angiography and the patient was scheduled for percutaneous coronary intervention (PCI). But after intracoronary (IC) injection of nitroglycerin, all of lesions disappeared completely and the diagnosis of coronary spasm was confirmed.
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Affiliation(s)
- Mohammad Ali Ostovan
- Cardiology Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran ; Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Sajedi Khanian
- Cardiology Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran ; Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahand Hamidi
- Cardiology Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran ; Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Fattahi
- Cardiology Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran ; Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooyan Dehghani
- Cardiology Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran ; Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Cardona-Guarache R, Pozen J, Jahangiri A, Koneru J, Shepard R, Roberts C, Abbate A, Cassano A. Thoracic Sympathectomy for Severe Refractory Multivessel Coronary Artery Spasm. Am J Cardiol 2016; 117:159-61. [PMID: 26522343 DOI: 10.1016/j.amjcard.2015.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/09/2015] [Accepted: 10/09/2015] [Indexed: 11/27/2022]
Abstract
Coronary artery spasm is a rare but potentially fatal disease. Herein, we report a case of recurrent ST-segment myocardial infarctions and ventricular fibrillation complicating severe multivessel coronary artery spasm successfully treated with bilateral thoracic surgical sympathectomy.
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Zhang ZP, Su X, Yang YC, Wu MX, Liu B, Liu CW. Cardiac arrest with coronary artery spasm: does the use of epinephrine during cardiopulmonary arrest exacerbate the spasm? Am J Emerg Med 2015; 33:479.e5-6. [DOI: 10.1016/j.ajem.2014.08.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 08/21/2014] [Indexed: 11/26/2022] Open
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Kang J, Hwang IC, Yoon CH. Successful Recovery after Cardiac Arrest from Medically Intractable Coronary Spasm Induced by Ergonovine, Using Percutaneous Cardiopulmonary Support - A Case Report -. Korean J Crit Care Med 2012. [DOI: 10.4266/kjccm.2012.27.4.269] [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)
- Jeehoon Kang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - In-Chang Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Bastante-Valiente T, González-Mansilla A, Parra-Fuertes JJ, Tascón-Pérez J. Espasmo coronario secuencial en angina variante de Prinzmetal con presentación sincopal. Rev Esp Cardiol 2008. [DOI: 10.1157/13116668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Asano T, Kobayashi Y, Ohno M, Nakayama T, Kuroda N, Komuro I. Multivessel Coronary Artery Spasm Refractory to Intensive Medical Treatment. Angiology 2007; 58:636-9. [PMID: 17906282 DOI: 10.1177/0003319707303583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This case report describes multivessel coronary artery spasm refractory to oral nifedipine, intravenous isosorbide dinitrate, diltiazem and nicorandil, and intracoronary nitroglycerin. Intracoronary administration of nicorandil only transiently relieved coronary artery spasm. Prednisolone was effective in preventing coronary artery spasm.
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Affiliation(s)
- Tatsuhiko Asano
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Ashikaga T, Nishizaki M, Fujii H, Niki S, Maeda S, Yamawake N, Kishi Y, Isobe M. Examination of the microcirculation damage in smokers versus nonsmokers with vasospastic angina pectoris. Am J Cardiol 2007; 100:962-4. [PMID: 17826378 DOI: 10.1016/j.amjcard.2007.04.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Revised: 04/06/2007] [Accepted: 04/13/2007] [Indexed: 12/15/2022]
Abstract
Endothelial dysfunction is considered one of the mechanisms underlying vasospastic angina pectoris (VSA). It is also known that smokers have abnormalities in endothelial dysfunction. Although smoking is a major risk factor for coronary artery disease, microvascular abnormalities have not been well shown. We investigated clinical characteristics and coronary reactivity with adenosine triphosphate in smokers with VSA. Twenty-two consecutive patients whose coronary spasm was documented in the left anterior descending (LAD) coronary artery with acetylcholine were enrolled. Coronary blood flow responses were also evaluated by intracoronary Doppler flow velocity recordings in the LAD coronary artery. Average peak velocities (APVs) were measured at baseline and intracoronary administration of adenosine triphosphate (50 microg) in 11 smokers (age 60+/-9 years; 8 men) and 11 nonsmokers (age 61+/-10 years, 5 men). Coronary flow reserve (CFR) was calculated by the ratio of baseline to hyperemic APV. Multivessel spasm was demonstrated in 6 smokers and only 2 nonsmokers (p<0.05). APV at rest in smokers (13.4+/-3.0 cm/s) was similar to that in nonsmokers (13.5+/-2.9 cm/s). However, CFR in smokers (2.6+/-0.7) was significantly lower than in nonsmokers (3.4+/-0.8; p<0.05). In conclusion, multivessel spasm was demonstrated in smokers in clinical settings, and microcirculation damage is prominent in smokers with VSA.
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Affiliation(s)
- Takashi Ashikaga
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, and Tokyo Medical and Dental University, Japan.
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Saito H, Itoh T, Itoh M, Kanaya Y, Suzuki T, Hiramori K. Simultaneous multivessel coronary spasm causing acute myocardial infarction: a case report. Angiology 2007; 58:112-7. [PMID: 17351167 DOI: 10.1177/0003319706297967] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spontaneous simultaneous multivessel coronary artery spasm in patients with acute myocardial infarction (AMI) is uncommon. A 79-year-old Japanese man was transferred to this hospital because of severe prolonged chest pain and faintness. Left coronary angiography revealed total occlusion of the left anterior descending and the left circumflex coronary arteries. Moreover, right coronary angiography revealed 99% stenosis of the right coronary artery. After intracoronary administration of nicorandil, left coronary artery and right coronary artery angiography revealed no organic stenosis or thrombus. This is the first report in which simultaneous 3-vessel spasm was documented by emergency angiography in AMI.
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Affiliation(s)
- Hidenori Saito
- Division of Cardiology, Memorial Heart Center, Iwate Medical University, Iwate Japan
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