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Rha SW, Lee K, Choi SY, Byun JK, Cha J, Hyun S, Ahn WJ, Park S, Kang DO, Park EJ, Choi CU, Choi BG. Long-term prognostic factors for cardiovascular events in patients with chest pain without diabetes mellitus nor significant coronary stenosis. Heart Vessels 2024; 39:382-391. [PMID: 38324195 DOI: 10.1007/s00380-023-02348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024]
Abstract
Chest pain is the most common symptom of coronary artery disease (CAD) and diabetes mellitus (DM) is a well-known single strongest risk factor for cardiovascular diseases. Thus, the impact of CAD nor DM on long-term clinical effects is reported widely, but the prognostic factors of non-DM patients presenting with chest pain without significant CAD are limited. A total of 1,046 patients with chest pain without DM and significant CAD who underwent coronary angiography (CAG) and acetylcholine (ACH) provocation tests were finally enrolled. Propensity score matching and multivariate Cox-proportional hazard ratio analysis were performed to adjust for baseline potential confounders. Major adverse cardiac and cerebrovascular events (MACCE) were defined as the composite of total death, myocardial infarction (MI), revascularization, stroke, and recurrent angina. This study aimed to evaluate the long-term prognostic factors for MACCE in patients with chest pain without DM and CAD up to 5 years. Coronary artery spasm (CAS) was the most common cause of chest pain. However, long-term MACCE of CAS was not worse than those of patients with chest pain without CAS when patients with CAS had subsequent optimal antianginal medication therapy. However, a recurrent chest pain remains a problem even with continuous antianginal medication therapy. Up to 5 years, the incidence of MACCE was in 7.3%, including recurrent angina 6.9%. Dyslipidemia (HR: 2.010, 95% CI 1.166-3.466, P = 0.012), mild-moderate (30-70%) coronary stenosis (HR: 2.369, 95% CI 1.118-5.018, P = 0.024), the use of aspirin (HR: 2.885, 95% CI 1.588-5.238, P < 0.001), and the use of nitrates (HR: 1.938, 95% CI 1.094-3.433, P = 0.023) were independent risk factors for MACCE. Among the patients with chest pain without DM and significant CAD, the incidence of MACE were rare, but recurrent angina was still a challenging problem who had treated with antianginal medications.
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Affiliation(s)
- Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea.
| | - Kyuho Lee
- Division of Cardiology, Department of Internal Medicine, Hwahong Hospital, Suwon, Korea
- Division of Cardiology, Department of Internal Medicine, Hwahong Hospital, Seoul, Korea
| | - Se Yeon Choi
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Jae Kyeong Byun
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Jinah Cha
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Sujin Hyun
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Woo Jin Ahn
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Soohyung Park
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Dong Oh Kang
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Eun Jin Park
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Cheol Ung Choi
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Byoung Geol Choi
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea.
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Jansen TPJ, Wentzel JJ, Damman P. Interplay between coronary bridging and high shear stress in the emergence of coronary vasospasm. Eur Heart J 2024; 45:737. [PMID: 37950497 PMCID: PMC10906982 DOI: 10.1093/eurheartj/ehad762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Affiliation(s)
- Tijn P J Jansen
- Cardiology, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, Netherlands
| | - Jolanda J Wentzel
- Cardiology, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, Netherlands
| | - Peter Damman
- Cardiology, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, Netherlands
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3
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Yaker ZS, Lincoff AM, Cho L, Ellis SG, Ziada KM, Zieminski JJ, Gulati R, Gersh BJ, Holmes D, Raphael CE. Coronary spasm and vasomotor dysfunction as a cause of MINOCA. EUROINTERVENTION 2024; 20:e123-e134. [PMID: 38224252 PMCID: PMC10786177 DOI: 10.4244/eij-d-23-00448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/15/2023] [Indexed: 01/16/2024]
Abstract
Increasing evidence has shown that coronary spasm and vasomotor dysfunction may be the underlying cause in more than half of myocardial infarctions with non-obstructive coronary arteries (MINOCA) as well as an important cause of chronic chest pain in the outpatient setting. We review the contemporary understanding of coronary spasm and related vasomotor dysfunction of the coronary arteries, the pathophysiology and prognosis, and current and emerging approaches to diagnosis and evidence-based treatment.
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Affiliation(s)
- Zachary S Yaker
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - A Michael Lincoff
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Leslie Cho
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Stephen G Ellis
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Khaled M Ziada
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - David Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Claire E Raphael
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Cai H, Chen S, Wang D. Sudden diffuse spasm of multiple coronary arteries: A case report. Medicine (Baltimore) 2024; 103:e36889. [PMID: 38215100 PMCID: PMC10783403 DOI: 10.1097/md.0000000000036889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024] Open
Abstract
RATIONALE Diffuse multivessel coronary artery spasm (DMV-CAS) was defined as a severe and reversible diffuse spasm occurring in more than 2 major coronary arteries, which is rare in clinical practice. Due to a wide lesion scope, DMV-CAS often occurs in the form of complications. It is not easy to be clinically diagnosed because it is too brief to be caught. Here, we report a rare case of spontaneous subtotal occlusion of 3 major coronary arteries induced by Vasalva action, which was confirmed in real-time by CAG. PATIENT CONCERNS A 68-year-old man had sudden chest pain after forced defecation during hospitalization. The electrocardiogram showed transient ST segment elevation of the inferior wall lead, inversion of the anterior wall, and lateral wall leads T waves. Emergency CAG revealed elongated vessel beds in 3 coronary arteries and multiple diffuse stenosis, but none of the coronary arteries were completely occlusive. DIAGNOSES Diagnoses of DMV-CAS were made based on CAG findings and postmedication response. INTERVENTIONS Nitroglycerin was administered in the coronary arteries. The anti-vasospasm, antiplatelet aggregation and lipid-regulating drugs were administered orally. OUTCOMES The patient was discharged on the 7th day with complete resolution of symptoms and normalization of the electrocardiography findings. No ischemic events occurred during a follow-up for 5 months. LESSONS This case highlights the identification of multivessel diffuse coronary spasm and acute myocardial infarction, and the prevention of CAS triggers, which requires the attention of clinicians.
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Affiliation(s)
- Hui Cai
- Department of Cardiology, Hebei General Hospital, Hebei North University, Shijiazhuang, Hebei Province, China
| | - Shuxia Chen
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
| | - Dongxiao Wang
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei Province, China
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Kurozumi A, Enomoto Y, Hara H, Kato N, Hiroi Y. A Case of Ventricular Fibrillation in Masked Long-QT Syndrome Coexisting with Coronary Vasospasm. Int Heart J 2024; 65:354-358. [PMID: 38556343 DOI: 10.1536/ihj.23-397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Although long-QT syndrome (LQTS) with a normal range QT interval at rest leads to fatal ventricular arrhythmias, it is difficult to diagnose. In this article, we present a rare case of a patient who suffered a cardiac arrest and was recently diagnosed with LQTS and coronary vasospasm. A 62-year-old man with no syncopal episodes had a cardiopulmonary arrest while running. During coronary angiography, vasospasm was induced and we prescribed coronary vasodilators, including calcium channel blockers. An exercise stress test was performed to evaluate the effect of medications and accidentally unveiled exercise-induced QT prolongation. He was diagnosed with LQTS based on diagnostic criteria. Pharmacotherapy and an implantable cardioverter defibrillator were used for his medical management. It is extremely rare for LQTS and coronary vasospasm to coexist. In cases of exercise-induced arrhythmic events, the exercise stress test might be helpful to diagnose underlying disease.
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Affiliation(s)
- Atsumasa Kurozumi
- Department of Cardiology, National Center for Global Health and Medicine
| | - Yoshinari Enomoto
- Department of Cardiology, National Center for Global Health and Medicine
| | - Hisao Hara
- Department of Cardiology, National Center for Global Health and Medicine
| | - Norihiro Kato
- Department of Cardiology, National Center for Global Health and Medicine
- Medical Genomics Center, National Center for Global Health and Medicine
| | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine
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Jenkins K, Pompei G, Ganzorig N, Brown S, Beltrame J, Kunadian V. Vasospastic angina: a review on diagnostic approach and management. Ther Adv Cardiovasc Dis 2024; 18:17539447241230400. [PMID: 38343041 PMCID: PMC10860484 DOI: 10.1177/17539447241230400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/17/2024] [Indexed: 02/15/2024] Open
Abstract
Vasospastic angina (VSA) refers to chest pain experienced as a consequence of myocardial ischaemia caused by epicardial coronary spasm, a sudden narrowing of the vessels responsible for an inadequate supply of blood and oxygen. Coronary artery spasm is a heterogeneous phenomenon that can occur in patients with non-obstructive coronary arteries and obstructive coronary artery disease, with transient spasm causing chest pain and persistent spasm potentially leading to acute myocardial infarction (MI). VSA was originally described as Prinzmetal angina or variant angina, classically presenting at rest, unlike most cases of angina (though in some patients, vasospasm may be triggered by exertion, emotional, mental or physical stress), and associated with transient electrocardiographic changes (transient ST-segment elevation, depression and/or T-wave changes). Ischaemia with non-obstructive coronary arteries (INOCA) is not a benign condition, as patients are at elevated risk of cardiovascular events including acute coronary syndrome, hospitalization due to heart failure, stroke and repeat cardiovascular procedures. INOCA patients also experience impaired quality of life and associated increased healthcare costs. VSA, an endotype of INOCA, is associated with major adverse events, including sudden cardiac death, acute MI and syncope, necessitating the study of the most effective treatment options currently available. The present literature review aims to summarize current data relating to the diagnosis and management of VSA and provide details on the sequence that treatment should follow.
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Affiliation(s)
- Kenny Jenkins
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Graziella Pompei
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Nandine Ganzorig
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Brown
- Cardiovascular Care Partnership, British Cardiovascular Society, London, UK
| | - John Beltrame
- Basil Hetzel Institute for Translational Health Research, Adelaide Medical School, University of Adelaide and Royal Adelaide Hospital and The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Medical School, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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7
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Zhang H, Wang P, Duan Z, Ma Y, Gong M, Pei H. Exploring the ECG "6+2" Phenomenon in Coronary Artery Disease and Coronary Artery Spasm: A Case Report Analysis and Treatment Implications. Am J Case Rep 2023; 24:e941692. [PMID: 37897036 PMCID: PMC10619700 DOI: 10.12659/ajcr.941692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/13/2023] [Accepted: 08/28/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Although coronary artery disease and coronary artery spasm (CAS) can lead to acute myocardial infarction, there are clear differences in treatment between coronary heart disease and CAS, and the therapeutic schedule should not be confused. Furthermore, electrocardiogram (ECG) "6+2" phenomenon is recommend as a specific ECG indicator for lesions in the left main coronary artery or multiple vessels. Currently, no reports of this phenomenon in CAS exist. CASE REPORT A 72-year-old man had history of recurrent chest pain for over 6 years, with episodes lasting about 10 min and resolving with rest. He experienced symptom recurrence and exacerbation due to substance abuse. He was admitted to our Emergency Department for chest pain at rest. His emergency ECG revealed a 6+2 phenomenon, accompanied by troponin levels exceeding 18 times the reference value. Promptly, we conducted coronary angiography, with unexpected normal findings. Following thorough assessment, we postulated the patient could have CAS. Subsequent to medical team intervention, the patient's ECG normalized, leading to his discharge upon condition stabilization. CONCLUSIONS We report a case of CAS in a patient with ECG 6+2 phenomenon, without significant coronary artery stenosis. This differs from transient ST-segment elevation on ECG, a well-recognized hallmark of CAS; however, such a presentation has not been documented before. Additionally, treatment strategies for myocardial ischemic conditions stemming from coronary atherosclerosis diverge from those employed for CAS. Therefore, clinicians should advocate for coronary angiography whenever feasible. This approach serves to elucidate the underlying disease etiology and facilitates the administration of precision-targeted interventions for patients.
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Affiliation(s)
- Hongyang Zhang
- Department of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan, PR China
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, PR China
| | - Peng Wang
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, PR China
| | - Zhen Duan
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, PR China
| | - Yao Ma
- Student Brigade of Basic Medicine School, Fourth Military Medical University, Xi’an, Shaanxi, PR China
| | - Meiting Gong
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, PR China
- College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, PR China
| | - Haifeng Pei
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, PR China
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8
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Zimodro JM, Mucha M, Chabior A, Gasecka A, Koltowski Ł. ST-segment elevation myocardial infarction and sudden cardiac arrest due to vasospastic angina: An underappreciated challenge. Kardiol Pol 2023; 81:1160-1162. [PMID: 37718583 DOI: 10.33963/v.kp.96981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Jakub Michał Zimodro
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland.
| | - Magda Mucha
- Faculty of Medicine, Medical University of Bialystok, Białystok, Poland
| | - Aleksandra Chabior
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Aleksandra Gasecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Łukasz Koltowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
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Ichinomiya T, Sekino M, Toba M, Yokoyama A, Iwasaki N, Kasai Y, Araki H, Yano R, Matsumoto S, Kurobe M, Sasaki R, Hara T. Refractory cardiac arrest caused by type I Kounis syndrome treated with adrenaline and nicorandil: A case report. Medicine (Baltimore) 2023; 102:e34535. [PMID: 37565887 PMCID: PMC10419590 DOI: 10.1097/md.0000000000034535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
RATIONALE Kounis syndrome is a rare but life-threatening anaphylactic reaction that can lead to acute coronary syndrome and cardiac arrest, and requires prompt diagnosis. Adrenaline, which is used to treat anaphylaxis, may cause coronary vasoconstriction and worsen ischemia, whereas coronary vasodilators may dilate systemic vessels and exacerbate hypotension. Delayed diagnosis of Kounis syndrome and inadequate therapeutic intervention may thus lead to a poor outcome. PATIENT CONCERNS A 59-year-old man was treated for sepsis due to a liver abscess. Following administration of daptomycin, the patient developed severe anaphylactic shock leading to refractory cardiac arrest. Because conventional cardiopulmonary resuscitation was ineffective, extracorporeal cardiopulmonary resuscitation was considered as an alternative approach. DIAGNOSES On bedside monitoring during cardiopulmonary resuscitation, unexpected ST-segment elevation was found on lead II electrocardiogram. Accordingly, the patient was clinically diagnosed with Kounis syndrome. INTERVENTIONS Nicorandil (6 mg/h), a coronary vasodilator with minimal blood pressure effects, was administered along with high doses of vasopressors, including adrenaline 0.2 µg/kg/min. OUTCOMES After the initiation of nicorandil administration, the patient achieved return of spontaneous circulation and did not require extracorporeal cardiopulmonary resuscitation. Based on the elevated serum tryptase level, normal creatine kinase-MB range, and lack of stenosis on coronary angiography, the patient was definitively diagnosed with type I (coronary vasospasm) Kounis syndrome. He was subsequently transferred to the referring hospital without neurological sequelae. LESSONS If anaphylaxis leads to refractory shock and cardiac arrest, ischemic changes on the electrocardiogram should be investigated to identify underlying Kounis syndrome. In addition to adrenaline, coronary dilators are the definitive treatment. Nicorandil may be a useful treatment option because of its minimal effect on blood pressure.
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Affiliation(s)
- Taiga Ichinomiya
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Motohiro Sekino
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Megumi Toba
- Department of Anesthesia, Sasebo City General Hospital, Nagasaki, Japan
| | - Akihiro Yokoyama
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoya Iwasaki
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yusuke Kasai
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Araki
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Rintaro Yano
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Sojiro Matsumoto
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaya Kurobe
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryu Sasaki
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsuya Hara
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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10
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Lim PO. Do Panic Attacks Causes Coronary Microvascular Spasm? Can J Cardiol 2023; 39:970. [PMID: 36871822 DOI: 10.1016/j.cjca.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/20/2023] [Accepted: 02/26/2023] [Indexed: 03/07/2023] Open
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11
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Hung MY, Hung MJ. Relationship between Inflammation and Vasospastic Angina. Medicina (Kaunas) 2023; 59:medicina59020318. [PMID: 36837519 PMCID: PMC9960836 DOI: 10.3390/medicina59020318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/29/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Coronary artery spasm (CAS) is a dynamic coronary stenosis causing vasospastic angina (VSA). However, VSA is a potentially lethal medical condition with multiple presentations, including sudden cardiac death. Despite investigations to explore its pathogenesis, no single mechanism has been found to explain the entire process of VSA occurrence. The roles of elevated local and systemic inflammation have been increasingly recognized in VSA. Treatment strategies to decrease local and systemic inflammation deserve further investigation.
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Affiliation(s)
- Ming-Yow Hung
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
| | - Ming-Jui Hung
- Section of Cardiovascular Imaging, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
- Correspondence:
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12
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Wang Y, Si G, Li X, Li J, Zhang R, Pan S. Simultaneous total occlusion due to spasm of 2 main coronary arteries: A case report. Medicine (Baltimore) 2023; 102:e32656. [PMID: 36637947 PMCID: PMC9839286 DOI: 10.1097/md.0000000000032656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Coronary artery spasm (CAS) defined by severe reversible focal or diffuse vasoconstriction, plays an essential role in the pathophysiology of acute coronary syndrome but is not very common in the clinic. Due to its transience, it is difficult to diagnose CAS directly, many patients are diagnosed by clinical experience. Here, we report the diagnosis and treatment of a rare case of simultaneous total occlusion due to spasm of the two main coronary arteries by coronary angiography (CAG). PATIENT CONCERNS A 47-year-old man with no medical history was admitted to our emergency room complaining of sudden-onset chest pain lasting 3 hours. Emergency CAG showed total occlusion of the proximal left anterior descending artery and right coronary artery. DIAGNOSES Acute myocardial infarction caused by CAS was diagnosed, according to CAG findings and test results. INTERVENTIONS Intracoronary injection of nitroglycerin and anti-spasm medication. OUTCOMES The patient was discharged on the 8th day with complete resolution of symptoms and normalization of the electrocardiography findings. No ischemic events occurred during a follow-up for 27 months. LESSONS This case highlights the significance of identifying CAS in patients with acute myocardial infarction and avoiding blind interventional stent therapy, which requires closer attention from clinicians.
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Affiliation(s)
- Yajing Wang
- Department of Cardiology, Jincheng People’s Hospital, Jincheng, China
- Department of Cardiology, Jincheng Hospital Affiliated to Changzhi Medical College, Jincheng, China
| | - Ganggang Si
- Department of Cardiology, Jincheng People’s Hospital, Jincheng, China
- Department of Cardiology, Jincheng Hospital Affiliated to Changzhi Medical College, Jincheng, China
| | - Xiangbing Li
- Department of Cardiology, Jincheng People’s Hospital, Jincheng, China
- Department of Cardiology, Jincheng Hospital Affiliated to Changzhi Medical College, Jincheng, China
| | - Jianjun Li
- Department of Cardiology, Jincheng People’s Hospital, Jincheng, China
- Department of Cardiology, Jincheng Hospital Affiliated to Changzhi Medical College, Jincheng, China
| | - Ruxia Zhang
- Department of Cardiology, Jincheng People’s Hospital, Jincheng, China
- Department of Cardiology, Jincheng Hospital Affiliated to Changzhi Medical College, Jincheng, China
| | - Sancong Pan
- Department of Cardiology, Jincheng People’s Hospital, Jincheng, China
- Department of Cardiology, Jincheng Hospital Affiliated to Changzhi Medical College, Jincheng, China
- * Correspondence: Sancong Pan, Department of Cardiology, Jincheng People’s Hospital, 456# Wenchang East Street, Shanxi, Jincheng 048000, China (e-mail: )
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Tateishi K, Kondo Y, Saito Y, Kitahara H, Fukushima K, Takahashi H, Yamashita D, Ohashi K, Suzuki K, Hashimoto O, Sakai Y, Kobayashi Y. Implantable cardioverter-defibrillator therapy after resuscitation from cardiac arrest in vasospastic angina: A retrospective study. PLoS One 2022; 17:e0277034. [PMID: 36315563 PMCID: PMC9621437 DOI: 10.1371/journal.pone.0277034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022] Open
Abstract
Patients with vasospastic angina (VSA) who are resuscitated from sudden cardiac arrest (SCA) are at a high risk of recurrent lethal arrhythmia and cardiovascular events. However, the benefit of the implantable cardioverter-defibrillator (ICD) therapy in this population has not been fully elucidated. The present study aimed to analyze the prognostic impact of ICD therapy on patients with VSA and SCA. A total of 280 patients who were resuscitated from SCA and received an ICD for secondary prophylaxis were included in the present multicenter registry. The patients were divided into two groups on the basis of the presence of VSA. The primary endpoint was a composite of all-cause death and appropriate ICD therapy (appropriate anti-tachycardia pacing and shock) for recurrent ventricular arrhythmias. Of 280 patients, 51 (18%) had VSA. Among those without VSA, ischemic cardiomyopathy was the main cause of SCA (38%), followed by non-ischemic cardiomyopathies (18%) and Brugada syndrome (7%). Twenty-three (8%) patients were dead and 72 (26%) received appropriate ICD therapy during a median follow-up period of 3.8 years. There was no significant difference in the incidence of the primary endpoint between patients with and without VSA (24% vs. 33%, p = 0.19). In a cohort of patients who received an ICD for secondary prophylaxis, long-term clinical outcomes were not different between those with VSA and those with other cardiac diseases after SCA, suggesting ICD therapy may be considered in patients with VSA and those with other etiologies who were resuscitated from SCA.
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Affiliation(s)
- Kazuya Tateishi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
- * E-mail:
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Kenichi Fukushima
- Department of Cardiovascular Medicine, Matsudo City General Hospital, Matsudo, Chiba, Japan
| | - Hidehisa Takahashi
- Department of Cardiovascular Medicine, Matsudo City General Hospital, Matsudo, Chiba, Japan
| | - Daichi Yamashita
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Koichi Ohashi
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Ko Suzuki
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Osamu Hashimoto
- Department of Cardiovascular Medicine, Chiba Emergency Medical Center, Chiba, Chiba, Japan
| | - Yoshiaki Sakai
- Department of Cardiovascular Medicine, Chiba Emergency Medical Center, Chiba, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
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14
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Cao Y, Luo X, Liu Q, Zhou S. Chest pain caused by left coronary artery spasm in a patient with anomalous origin of right coronary artery. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2022; 47:679-684. [PMID: 35753739 PMCID: PMC10929908 DOI: 10.11817/j.issn.1672-7347.2022.210292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 06/15/2023]
Abstract
Anomalous origin of coronary artery is rare and important reason of chest pain, syncope, and sudden death in young and middle-aged patients. This case reported a patient with interarterial anomalous right coronary artery and chest pain, which was confirmed to be the result of severe vasospasm of the proximal left anterior descending artery. The patient had reoccurred spontaneous chest pain and the dynamic ST segment and T wave changes at anterior walls. Coronary angiography confirmed left coronary artery spasm. Chest pain was controlled by diltiazem and isosorbide mononitrate. During 3 months of follow-up after discharge, the patient did not have chest pain anymore.
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Affiliation(s)
- Yuanyuan Cao
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China.
| | - Xiaolan Luo
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Qiming Liu
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China
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15
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Eun Park H, Na SH, Do Shin S, Wi J, Kim SH, Choi J, Choi JI, Cho Y, Cha MJ, Kim KH. Does Coronary Vasospasm Show a Better Prognosis in Out of Hospital Cardiac Arrest: Data from the Korean Cardiac Arrest Research Consortium (KoCARC) Registry. Anatol J Cardiol 2022; 26:450-459. [PMID: 35703481 PMCID: PMC9361063 DOI: 10.5152/anatoljcardiol.2022.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Methods: Results: Conclusions:
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Affiliation(s)
- Hyo Eun Park
- Department of Internal Medicine, Division of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Sang-Hoon Na
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Korea
- Corresponding author:Sang-Hoon Na ✉ ,
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Wi
- Department of Internal Medicine, Division of Cardiology, Gachon University Gil Medical Center, Seoul, Korea
| | - Sang-Hyun Kim
- Department of Internal Medicine, Division of Cardiology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jinho Choi
- Department of Internal Medicine, Division of Cardiology, Samsung Medical Center, Seoul, Korea
| | - Jong-Il Choi
- Department of Internal Medicine, Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - Youngjin Cho
- Department of Internal Medicine, Division of Cardiology, Seoul National University Bundang Hospital, Seoul, Korea
| | - Myung-Jin Cha
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Hee Kim
- Department of Internal Medicine, Division of Cardiology, Sejong General Hospital, Seoul, Korea
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16
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Ajith A, Corbett M, Garry S, Young O. Case of coronary vasospasm caused by hypocalcaemia post parathyroidectomy mimicking ST-elevation myocardial infarction. BMJ Case Rep 2022; 15:e247919. [PMID: 35450875 PMCID: PMC9024207 DOI: 10.1136/bcr-2021-247919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/03/2022] Open
Abstract
A man in his 30s with primary hyperparathyroidism underwent an elective four-gland parathyroid exploration with intraoperative parathyroid hormone monitoring. On the fourth postoperative day (POD), the patient presented to the emergency department with severe symptomatic hypocalcaemia. ECG findings were in keeping with inferior-posterior ST-elevation myocardial infarction (STEMI); however, he was asymptomatic with no chest pain. Biochemistry revealed elevated serial troponin levels. Coronary angiogram and transthoracic echocardiogram were normal, suggesting coronary vasospasm, mimicking STEMI on ECG because of severe hypocalcaemia post parathyroidectomy. This is an uncommon and unreported complication of parathyroid surgery. The patient was successfully managed with intravenous calcium and discharged on oral calcium replacement on the tenth POD.
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Affiliation(s)
- Aiswarya Ajith
- ENT department, Galway University Hospital, Galway, Ireland
| | - Mel Corbett
- ENT department, Galway University Hospital, Galway, Ireland
| | - Stephen Garry
- ENT department, Galway University Hospital, Galway, Ireland
| | - Orla Young
- ENT department, Galway University Hospital, Galway, Ireland
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17
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Kolos IP, Chernyshova VA, Konstantinova EV, Gilyarov MY. [Capecitabine and vasospastic angina: a clinical case]. Kardiologiia 2022; 62:36-41. [PMID: 35272606 DOI: 10.18087/cardio.2022.2.n1708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/30/2021] [Indexed: 06/14/2023]
Abstract
The article presents a clinical case of a 78-year-old female patient with a clinical picture of vasospastic angina during the capecitabin treatment. The issues under discussion include difficulties of diagnosing vasospastic angina, a potential danger and incidence of coronary vasospastic reactions during chemotherapy with drugs of this group, and current approaches to prevention and correction of fluoropyrimidine cardiotoxicity. The presented clinical case confirms that vasospasm is a manifestation of capecitabin cardiotoxicity. This case also illustrates the importance of interaction and co-ordination of the work of oncologists and cardiologists at all stages of care of oncological patients.
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Affiliation(s)
- I P Kolos
- Medical Center of the Federal Property Management Agency, Moscow, Russia
| | | | - E V Konstantinova
- N.I. Pirogov Municipal Clinical Hospital #1, Moscow, Russia "Pirogov Russian National Research Medical University", Moscow, Russia
| | - M Yu Gilyarov
- N.I. Pirogov Municipal Clinical Hospital #1, Moscow, Russia "Pirogov Russian National Research Medical University", Moscow, Russia
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18
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Abstract
The underlying mechanisms of coronary spastic angina (CSA) is not well understood. It is unclear if an infection can trigger coronary vasospasm; the co-occurrence of sepsis and CSA has rarely been reported. We describe the case of a 47-year-old man who suddenly developed a complete atrioventricular block and an episode of cardiac arrest while undergoing treatment for sepsis secondary to invasive group A streptococci. Emergency coronary angiography and provocation revealed spasm of the right coronary artery, which had led to the atrioventricular block. The spasm was relieved following administration of calcium-channel blockade, and no subsequent recurrence was documented. Due to several underlying mechanisms, sepsis may be a potential risk factor of coronary spasm and episodes of this condition have been missed or misdiagnosed. Physicians should be aware of CSA as a potential complication during treatment of sepsis.
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Affiliation(s)
- Tatsuya Sakagami
- Department of Emergency, Tokyo Kita Medical Center, Kita-ku, Japan
| | - Takeshi Tsuji
- Department of Cardiology, Tokyo Kita Medical Center, Kita-ku, Japan
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19
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Wayama K, Takagi K, Fujino M, Noguchi T. Permanent collateral circulation due to vasospasm angina. Cardiovasc Interv Ther 2021; 37:400-401. [PMID: 34304348 DOI: 10.1007/s12928-021-00794-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/04/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Keima Wayama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan.
| | - Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
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20
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Sekine T, Kamioka M, Hijioka N, Yamada S, Kaneshiro T, Takeishi Y. Symptomatic Long QT Syndrome Coexisting with Asymptomatic Acetylcholine-induced Vasospasm. Intern Med 2021; 60:2085-2088. [PMID: 33518575 PMCID: PMC8313919 DOI: 10.2169/internalmedicine.6475-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We herein report a rare case of long QT syndrome (LQTS) coexisting with acetylcholine (Ach)-induced vasospasm. A 31-year-old woman experienced cardiopulmonary arrest during running. LQTS was diagnosed by an electrocardiogram, and the coexistence of Ach-induced vasospam was determined by an Ach provocation test on coronary angiography. Although an implantable cardioverter defibrillator was placed, a beta-blocker was not prescribed for two reasons: first, the patient showed Ach-induced vasospasm alone with no symptoms and no ST change by Ach injection, and second, the use of beta-blockers alone in such patients carries a risk of vasospasm-induced ventricular fibrillation.
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Affiliation(s)
- Toranosuke Sekine
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Masashi Kamioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Naoko Hijioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Shinya Yamada
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Takashi Kaneshiro
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
- Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
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21
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Gembillo G, Siligato R, Cernaro V, Satta E, Conti G, Salvo A, Romeo A, Calabrese V, Sposito G, Ferlazzo G, Santoro D. Monocyte to HDL ratio: a novel marker of resistant hypertension in CKD patients. Int Urol Nephrol 2021; 54:395-403. [PMID: 34109496 DOI: 10.1007/s11255-021-02904-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/30/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Inflammation, oxidative stress (OS), atherosclerosis and resistant hypertension (RH) are common features of chronic kidney disease (CKD) leading to a higher risk of death from cardiovascular disease. These effects seem to be modulated by impaired anti-oxidant, anti-inflammatory and reverse cholesterol transport actions of high-density lipoprotein cholesterol (HDL). HDL prevents and reverses monocyte recruitment and activation into the arterial wall and impairs endothelial adhesion molecule expression. Recently, monocyte count to HDL-cholesterol ratio (MHR) has emerged as a potential marker of inflammation and OS, demonstrating to be relevant in CKD. Our research was aimed to assess, for the first time, its reliability in RH. METHODS We performed a retrospective study on 214 patients with CKD and arterial hypertension who were admitted between January and June 2019 to our Department, 72 of whom were diagnosed with RH. RESULTS MHR appeared inversely related to eGFR (ρ = - 0.163; P = 0.0172). MHR was significantly higher among RH patients compared to non-RH ones (12.39 [IQR 10.67-16.05] versus 7.30 [5.49-9.06]; P < 0.0001). Moreover, MHR was significantly different according to the number of anti-hypertensive drugs per patient in the whole study cohort (F = 46.723; P < 0.001) as well as in the non-RH group (F = 14.191; P < 0.001). Moreover, MHR positively correlates with diabetes mellitus (ρ = 0.253; P = 0.0002), white blood cells (ρ = 0.664; P < 0.0001) and C-reactive protein (ρ = 0.563; P < 0.0001). CONCLUSIONS MHR may be a reliable biomarker due to the connection between HDL and monocytes. Our study suggests that MHR is linked with the use of multiple anti-hypertensive therapy and resistant hypertension in CKD patients, and can be a useful ratio to implement appropriate treatment strategies.
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Affiliation(s)
- Guido Gembillo
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy.
| | - Rossella Siligato
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Valeria Cernaro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Ersilia Satta
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy
| | | | - Antonino Salvo
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Adolfo Romeo
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Vincenzo Calabrese
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Giovanna Sposito
- Pediatric Nephrology Unit, AOU Policlinic "G Martino", University of Messina, 98125, Messina, Italy
- Laboratory of Immunology and Biotherapy, Department of Human Pathology, University of Messina, Messina, Italy
| | - Guido Ferlazzo
- Pediatric Nephrology Unit, AOU Policlinic "G Martino", University of Messina, 98125, Messina, Italy
- Laboratory of Immunology and Biotherapy, Department of Human Pathology, University of Messina, Messina, Italy
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.
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22
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Saad Shaukat MH, Wilson J, Stys A. Segmental Coronary Vasospasm Mimicking ST-Elevation Myocardial Infarction in an Incidentally COVID-Positive Patient. S D Med 2021; 74:248-249. [PMID: 34449162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Coronary vasospasm is an underdiagnosed cause of myocardial infarction in the absence of obstructive coronary artery disease. Systemic inflammation is one of several triggers associated with coronary vasospasm. We report the case of a 47-year woman incidentally found to be COVID-positive (RT-PCR) during evaluation of constitutional symptoms and breast cellulitis. Later in the hospitalization, she developed sudden-onset typical angina at rest; 12 lead EKG showed inferolateral ST-elevations. Urgent coronary angiogram showed nitrate-responsive subtotal focal occlusions in the right coronary and circumflex arteries. In the absence of sepsis, it is difficult to attribute coronary vasospasm solely to cellulitis. Focal coronary artery spasm mimicking ST-elevation myocardial infarction successfully managed solely with intracoronary nitroglycerine in an incidentally COVID-positive patient adds to the diverse manifestations of COVID infection. The exact mechanism of focal, as opposed to diffuse coronary vasospasm is unclear.
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Affiliation(s)
| | - Jeffrey Wilson
- Department of Cardiology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Adam Stys
- Department of Cardiology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
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23
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Cho SS, Jo SH, Kim HJ, Lee MH, Seo WW, Kim HL, Lee KY, Yang TH, Her SH, Han SH, Lee BK, Park KH, Rha SW, Gwon HC, Choi DJ, Baek SH. Smoking may be more harmful to vasospastic angina patients who take antiplatelet agents due to the interaction: Results of Korean prospective multi-center cohort. PLoS One 2021; 16:e0248386. [PMID: 33798225 PMCID: PMC8018640 DOI: 10.1371/journal.pone.0248386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background The interaction between smoking and the use of antiplatelet agents on the prognosis of vasospastic angina (VA) is rarely investigated. Methods VA-Korea is a nation-wide multi-center registry with prospective design (n = 1812). The primary endpoint was the composite occurrence of acute coronary syndrome (ACS), symptomatic arrhythmia, and cardiac death. Log-rank test and Cox proportional hazard model were for statistical analysis. Also, we conducted interaction analysis in both additive and multiplicative scales between smoking and antiplatelet agents among VA patients. For additive scale interaction, relative excess risk due to interaction (RERI) was calculated and for multiplicative scale interaction, the ratio of hazard ratio (HR) was calculated. All statistical analysis conducted by Stata Ver 16.1. Results Patients who were smoking and using antiplatelet agents had the highest incidence rate in the primary composite outcome. The incidence rate was 3.49 per 1,000 person-month (95% CI: 2.30-5.30, log-rank test for primary outcome p = 0.017) and HR of smoking and using antiplatelet agents was 1.66 (95%CI: 0.98-2.81). The adjusted RERI of smoking and using antiplatelet agents was 1.10 (p = 0.009), and the adjusted ratio of HR of smoking and using antiplatelet agents was 3.32 (p = 0.019). The current study observed the interaction between smoking and using antiplatelet agents in both additive and multiplicative scales. Conclusions Smoking was associated with higher rates of unfavorable clinical outcomes among VA patients taking antiplatelet agents. This suggested that VA patients, especially those using antiplatelet agents should quit smoking.
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Affiliation(s)
- Seong-Sik Cho
- Department of Occupational and Environmental Medicine, College of Medicine Dong-A University, Busan, Korea
- Department of Preventive Medicine, College of Medicine Dong-A University, Busan, Korea
| | - Sang-Ho Jo
- Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
- * E-mail: (SHJ); (SHB)
| | - Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Min-Ho Lee
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Won-Woo Seo
- Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kwan Yong Lee
- Department of Cardiovascular Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Tae-Hyun Yang
- Department of Cardiovascular Medicine, Busan Paik Hospital, Inje University, Busan, South Korea
| | - Sung-Ho Her
- Department of Cardiovascular Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Seung Hwan Han
- Department of Cardiovascular Medicine, Gil Medical Center, Gachon University, Incheon, South Korea
| | - Byoung-Kwon Lee
- Department of Cardiovascular Medicine, Gangnam Severance Hospital, Yonsei University, Seoul, South Korea
| | - Keun-Ho Park
- The Heart Center, Chosun Medical Center, Gwangju, South Korea
| | - Seung-Woon Rha
- Department of Cardiovascular Medicine, Guro Hospital, Korea University, Seoul, South Korea
| | - Hyeon-Cheol Gwon
- Department of Cardiovascular Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Dong-Ju Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang Hong Baek
- Division of Cardiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
- * E-mail: (SHJ); (SHB)
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24
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Seo WW, Jo SH, Kim SE, Kim HJ, Han SH, Lee KY, Her SH, Lee MH, Cho SS, Kim HL, Baek SH. Admission serum potassium levels and prognosis of vasospastic angina. Sci Rep 2021; 11:5707. [PMID: 33707512 PMCID: PMC7952915 DOI: 10.1038/s41598-021-84712-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 02/18/2021] [Indexed: 11/18/2022] Open
Abstract
Hypokalemia is a common electrolyte disturbance and is related to poor prognosis in patients with cardiovascular disease. However, the role of hypokalemia in patients with vasospastic angina (VSA) has not yet been studied. The present study enrolled 1454 patients diagnosed with VSA according to ergonovine provocation test results and available admission serum potassium data. The primary outcome was a composite of cardiac death, acute coronary syndrome, and new-onset life-threatening arrhythmia. Based on a hypokalemia definition as serum potassium concentration ≤ 3.5 mEq/L, the hypokalaemia group included 70 patients (4.8%). The median potassium levels were 3.4 mEq/L [interquartile range (IQR) 3.3-3.5] in the hypokalemia group and 4.1 mEq/L (IQR 3.9-4.3) in the no-hypokalemia group. The median follow-up duration was 764 days. Primary outcomes occurred in seven patients (10.0%) in the hypokalemia group and 51 patients (3.7%) in the no-hypokalemia group. The Kaplan-Meier analysis showed a higher cumulative incidence of primary outcomes in the hypokalemia group compared to that in the no-hypokalemia group (log-rank P = 0.014). Multivariate Cox regression analysis also showed that hypokalemia was an independent predictor of primary outcomes. In conclusion, hypokalemia at admission was associated with adverse clinical outcomes in VSA.
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Affiliation(s)
- Won-Woo Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea.
| | - Sung Eun Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Seung Hwan Han
- Department of Cardiovascular Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Kwan Yong Lee
- Department of Cardiovascular Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Sung Ho Her
- Department of Cardiovascular Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Min-Ho Lee
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Seong-Sik Cho
- Department of Occupational and Environmental Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Hong Baek
- Department of Cardiovascular Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Saleh Z, Koshy S, Sidhu V, Opgenorth A, Senaratne J. Spontaneous coronary artery dissection in association with cabergoline therapy. BMJ Case Rep 2021; 14:e240022. [PMID: 33563672 PMCID: PMC7875262 DOI: 10.1136/bcr-2020-240022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2021] [Indexed: 11/04/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognised cause of acute coronary syndrome. While numerous risk factors are associated with SCAD, one potential cause is coronary artery vasospasm. The use of cabergoline-an ergot derivative and dopamine agonist that may induce vasospasm-has been associated with SCAD in one other case report worldwide. Here, we describe SCAD in a 37-year-old woman on long-term cabergoline therapy with no other cardiac risk factors. Cabergoline-induced SCAD should be considered in patients presenting with an acute coronary syndrome who are treated with this medication.
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Affiliation(s)
- Zia Saleh
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Koshy
- Division of Cardiology, Grey Nuns Hospital, Edmonton, Alberta, Canada
| | - Vaninder Sidhu
- Division of Cardiology, Grey Nuns Hospital, Edmonton, Alberta, Canada
| | - Andrea Opgenorth
- Division of Cardiology, Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Janek Senaratne
- Division of Cardiology, Department of Medicine, University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada
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Tang Y, Yang H, Liu P, Zeng Y, Liu Z, Tang M, He J, Peng J, Pan H, Zhang Y, Zheng Z. Acute Myocarditis Triggers Coronary Artery Spasm: A Rare Association. J Emerg Med 2020; 58:962-966. [PMID: 32376061 DOI: 10.1016/j.jemermed.2020.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/07/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Yi Tang
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, Hunan, China
| | - Hua Yang
- Department of Electrocardiography, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, Hunan, China
| | - Peng Liu
- Department of Radiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, Hunan, China
| | - Yanfeng Zeng
- Department of Radiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, Hunan, China
| | - Zhengyu Liu
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, Hunan, China
| | - Mingxiang Tang
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, Hunan, China
| | - Jin He
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, Hunan, China
| | - Jianqiang Peng
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, Hunan, China
| | - Hongwei Pan
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, Hunan, China
| | - Yi Zhang
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, Hunan, China
| | - Zhaofen Zheng
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, Hunan, China
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Abstract
A 61-year-old man experienced chest oppression for 1 hour. He was positive for troponin T and underwent emergent coronary angiography (CAG), which did not reveal significant coronary stenosis. He was diagnosed with myocardial infarction with nonobstructive coronary arteries (MINOCA). We performed a spasm-provocation test, which revealed a focal spasm at the segment of the myocardial bridge. After receiving a calcium-channel blocker, he exhibited a good clinical course. Coronary spasm is considered an underlying cause of MINOCA; therefore, the presence of a myocardial bridge may help with the diagnosis.
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Affiliation(s)
- Hiroki Teragawa
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Japan
| | - Chikage Oshita
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Japan
| | - Tomohiro Ueda
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Japan
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Pikkarainen E, Blomster J, Sipilä J, Rautava P, Kytö V. Occurrence and mortality of vasospastic angina pectoris hospitalised patients in Finland: a population-based registry cohort study. BMJ Open 2019; 9:e030768. [PMID: 31685505 PMCID: PMC6858179 DOI: 10.1136/bmjopen-2019-030768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The occurrence and mortality of vasospastic angina pectoris (VAP) is largely unknown in western countries. Our objective was to clarify the occurrence, gender-distribution and mortality of VAP in Finland using a population-based hospital registry. METHODS We studied consecutive patients aged ≥18 years hospitalized with VAP as the primary cause of admission in Finland during 2004-2014. The data were collected from obligatory nationwide registries. During the study period 1762 admissions were recorded. RESULTS Majority of all VAP patients were male (59.7%) and mean age was 65.7±12.0 years. Annual admission rate for VAP was 2.29/100 000 person-years. Men were in higher risk for VAP than women (admission rate 3.00/100 000 vs 1.68/100 000; RR 1.70; p<0.0001). Gender difference was not modified by age. Likelihood of VAP was highest in population aged 70-84 years. Admission rate for VAP decreased notably during the study period. One-year all-cause mortality was 8.0% and 3-year mortality was 15.5% (cardiac mortality 11.1%). Mortality was associated with increasing age, comorbidity burden and lack of detected coronary artery obstruction, but was similar between genders and during the study period. CONCLUSIONS Men have higher risk for vasospastic angina caused admissions. Likelihood of vasospastic angina admission was highest in aged population. The 3-year all-cause mortality was 15.5%. Mortality was associated with increasing age, comorbidities and non-obstructive VAP diagnosis but was similar between genders.
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Affiliation(s)
| | | | - Jussi Sipilä
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
- Department of Neurology, Turku University Hospital, Turku, Finland
- Department of Neurology, Siun Sote, North Carelia Central Hospital, Joensuu, Finland
| | - Päivi Rautava
- Department of Neurology, Siun Sote, North Carelia Central Hospital, Joensuu, Finland
| | - Ville Kytö
- Heart Centre, Turku University Hospital, Turku, Finland
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29
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Oshima Y, Yamasaki K, Otsuki A, Nakasone M, Endo R, Moriyama N, Sakamoto S, Minami Y, Inagaki Y. Peripartum myocardial infarction associated with coronary spasm and acquired protein S deficiency: A case report. Medicine (Baltimore) 2019; 98:e18108. [PMID: 31770234 PMCID: PMC6890345 DOI: 10.1097/md.0000000000018108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Coronary angiography (CAG) findings of acute myocardial infarction (AMI) in pregnant women are characterized by a high incidence of normal coronary arteries. This is the first report of AMI with normal coronary arteries during pregnancy, showing coronary spasm and pregnancy-related acquired protein S (PS) deficiency. PATIENT CONCERNS A 30-year-old Japanese woman was admitted to an emergency department. One hour before admission, she developed sudden onset of precordial discomfort, back pain, and dyspnea. She was a primigravida at 39 weeks' gestation and had no abnormality in the pregnancy thus far. She had no history of heart disease, diabetes, hypertension, dyslipidemia, deep vein thrombosis (DVT), smoking, or oral contraceptive use and no family history of ischemic heart disease, hemostasis disorder, or DVT. She did not take any medication. DIAGNOSIS Electrocardiography showed ST-segment elevations in leads II, III, aVF, and V2-V6. Heart-type fatty acid-binding protein was positive. Echocardiography showed hypokinesis of the anterior interventricular septum and inferior wall. Continuous intravenous infusion of isosorbide dinitrate was initiated. Coronary computed tomography angiography revealed diffuse narrowing of the apical segment of the left anterior descending coronary artery. Three hours after admission, troponin T became positive, and the following enzymes reached their peak levels: creatine kinase (CK), 1,886 U/L; CK-muscle/brain, 130 U/L. She was diagnosed with transmural AMI due to severe coronary spasm and administered benidipine hydrochloride. Five hours after admission, premature membrane rupture occurred. INTERVENTIONS Emergency cesarean section was performed. There were no anesthetic or obstetrical complications during the operation. On postpartum day 1, the free PS antigen level was low (29%). On postpartum day 18, she was discharged with no reduction in physical performance. OUTCOMES Four months after the infarction, CAG showed normal coronary arteries. Acetylcholine provocation test showed diffuse vasospasm in the coronary artery. She was advised that her next pregnancy should be carefully planned. Two years after delivery, free PS antigen level was within normal range, at 86%. She had not experienced recurrence of angina during the 2-year period. Her child was also developing normally. LESSONS In addition to coronary spasm, pregnancy-related acquired PS deficiency may be involved in AMI etiology.
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Affiliation(s)
| | - Kazumasa Yamasaki
- Division of Anesthesiology and Critical Care Medicine, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Akihiro Otsuki
- Division of Anesthesiology and Critical Care Medicine, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Masato Nakasone
- Division of Anesthesiology and Critical Care Medicine, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Ryo Endo
- Division of Anesthesiology and Critical Care Medicine, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Naoki Moriyama
- Division of Anesthesiology and Critical Care Medicine, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Seiji Sakamoto
- Division of Anesthesiology and Critical Care Medicine, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Yukari Minami
- Division of Anesthesiology and Critical Care Medicine, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Yoshimi Inagaki
- Division of Anesthesiology and Critical Care Medicine, Department of Surgery, Tottori University Faculty of Medicine, Tottori, Japan
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Oikonomou E, Chrysohoou C, Vlachopoulos C, Tousoulis D. The aetiology of death for marathon runner Phidippides? Eur Heart J 2019; 40:2564-2565. [PMID: 31411721 DOI: 10.1093/eurheartj/ehz560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Evangelos Oikonomou
- 1st Cardiology Department, National and Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece
| | - Christina Chrysohoou
- 1st Cardiology Department, National and Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece
| | - Charalambos Vlachopoulos
- 1st Cardiology Department, National and Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Department, National and Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece
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31
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Bianchi S, Aucella F, De Nicola L, Genovesi S, Paoletti E, Regolisti G. Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology. J Nephrol 2019; 32:499-516. [PMID: 31119681 PMCID: PMC6588653 DOI: 10.1007/s40620-019-00617-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 05/05/2019] [Indexed: 12/11/2022]
Abstract
Hyperkalemia (HK) is the most common electrolyte disturbance observed in patients with kidney disease, particularly in those in whom diabetes and heart failure are present or are on treatment with renin-angiotensin-aldosterone system inhibitors (RAASIs). HK is recognised as a major risk of potentially life threatening cardiac arrhythmic complications. When an acute reduction of renal function manifests, both in patients with chronic kidney disease (CKD) and in those with previously normal renal function, HK is the main indication for the execution of urgent medical treatment and the recourse to extracorporeal replacement therapies. In patients with end-stage renal disease, the presence of HK not responsive to medical therapy is an indication at the beginning of chronic renal replacement therapy. HK can also be associated indirectly with the progression of CKD, because the finding of high potassium values leads to withdrawal of treatment with RAASIs, which constitute the first choice nephro-protective treatment. It is therefore essential to identify patients at risk of developing HK, and to implement therapeutic interventions aimed at preventing and treating this dangerous complication of kidney disease. Current strategies aimed at the prevention and treatment of HK are still unsatisfactory, as evidenced by the relatively high prevalence of HK also in patients under stable nephrology care, and even in the ideal setting of randomized clinical trials where optimal treatment and monitoring are mandatory. This position paper will review the main therapeutic interventions to be implemented for the prevention, detection and treatment of HK in patients with CKD on conservative care, in those on dialysis, in patients in whom renal disease is associated with diabetes, heart failure, resistant hypertension and who are on treatment with RAASIs, and finally in those presenting with severe acute HK.
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Affiliation(s)
- Stefano Bianchi
- Nephrology and Dialysis Unit, Department of Internal Medicine, Azienda ASL Toscana Nord Ovest, Livorno, Italy
| | - Filippo Aucella
- Nephrology and Dialysis Unit, IRCCS “Casa Sollievo della Sofferenza” Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy
| | - Luca De Nicola
- Division of Nephrology, University of Campania, Naples, Italy
| | - Simonetta Genovesi
- Department of Medicine and Surgery, University of Milano - Bicocca San Gerardo Hospital, Nephrology Unit, Monza, Italy
| | - Ernesto Paoletti
- Nephrology, Dialysis and Transplantation, University of Genoa and Policlinico, San Martino Genoa, Italy
| | - Giuseppe Regolisti
- Acute and Chronic Renal Failure Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
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32
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Laeeq R, Berman JS, Khalid U, Lakkis NM, Tabbaa R. Reversible Cerebral Vasoconstriction Syndrome Associated with Coronary Artery Vasospasm. Tex Heart Inst J 2019; 46:139-142. [PMID: 31236082 DOI: 10.14503/thij-17-6403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Reversible cerebral vasoconstriction syndrome is a rare disorder associated with neurologic symptoms secondary to diffuse cerebral vasospasm. Cardiac involvement in this disease is exceedingly rare. A 50-year-old woman was admitted to our hospital for evaluation of chest pain. During a 3-year period, she had been admitted multiple times because of chest pain and elevated serum cardiac enzymes. Transthoracic echocardiograms showed transient wall-motion abnormalities; however, coronary angiograms revealed no coronary artery disease. At the current admission, she had a thunderclap headache, and cerebral angiograms revealed diffuse cerebral vasoconstriction that improved after verapamil infusion, confirming the diagnosis of reversible cerebral vasoconstriction syndrome. The patient was treated successfully with oral diltiazem and had no recurrence of symptoms. We describe what we think is the first reported case of coronary artery spasm in association with reversible cerebral vasoconstriction syndrome. Future research should be focused on identifying treatment options and defining the mechanisms by which the cerebral and coronary vasculature are affected.
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33
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Park SJ, Park H, Kang D, Park TK, Park J, Cho J, Chung CR, Jeon K, Guallar E, Cho J, Suh GY, Yang JH. Association of statin therapy with clinical outcomes in patients with vasospastic angina: Data from Korean health insurance review and assessment service. PLoS One 2019; 14:e0210498. [PMID: 30699150 PMCID: PMC6353127 DOI: 10.1371/journal.pone.0210498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/22/2018] [Indexed: 11/18/2022] Open
Abstract
There is conflicting evidence for the clinical benefit of statin therapy in patients with vasospastic angina (VSA). We investigated the association of statin therapy with clinical outcomes in relatively large populations with clinically suspected VSA from a nationwide population-based database. Data were collected from the Health Insurance Review and Assessment database records of 4,099 patients that were in an intensive care unit with VSA between January 1, 2008 and May 31, 2015. We divided the patients into a statin group (n = 1,795) and a non-statin group (n = 2,304). The primary outcome was a composite of cardiac arrest and acute myocardial infarction (AMI). The median follow-up duration was 3.8 years (interquartile range: 2.2 to 5.8 years). Cardiac arrest or AMI occurred in 120 patients (5.2%) in the statin group, and 97 patients (5.4%) in the non-statin group (P = 0.976). With inverse probability of treatment weighting, there was no significant difference in the rate of cardiac arrest or AMI between the two groups (adjusted hazard ratio [HR], 0.99; 95% confidence interval [CI], 0.76–1.30; P = 0.937), or even between the non-statin group and high-intensity statin group (adjusted HR, 1.08; 95% CI, 0.69–1.70; P = 0.75). The beneficial association of statin use with the primary outcome was consistently lacking across the various comorbidity types. Statin therapy was not associated with reduced cardiac arrest or AMI in patients with VSA, regardless of statin intensity. Prospective, randomized trials will be needed to confirm our findings.
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Affiliation(s)
- So Jin Park
- Department of Pharmaceutical Services, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyejeong Park
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinkyeong Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joongbum Cho
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eliseo Guallar
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Gee Young Suh
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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34
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Wang G, Zhao N, Zhang C, Zhong S, Li X. Lambda-like ST-segment elevation in acute myocardial infarction triggered by coronary spasm may be a new risk predictor for lethal ventricular arrhythmia: A case report. Medicine (Baltimore) 2018; 97:e13561. [PMID: 30544473 PMCID: PMC6310568 DOI: 10.1097/md.0000000000013561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The lambda-like ST-elevation electrocardiography (ECG) pattern is extremely rare in patients with type 2 myocardial infarction (T2MI) triggered by coronary spasm. When this ECG pattern appears, sudden cardiac death (SCD) caused by lethal ventricular arrhythmia may occur because clinicians do not pay sufficient attention to this phenomenon. PATIENT CONCERNS We describe a 41-year-old man who presented with steep down-sloping ST-segment elevation, paroxysmal ventricular tachycardia, severe sinus bradycardia, and intermittent complete atrioventricular block on ECG during the sudden recurrence of clinical symptoms. DIAGNOSIS T2MI complicated with lethal arrhythmia and caused by coronary spasm. INTERVENTIONS The patient received an implantable cardioverter defibrillator (ICD) for SCD caused by lethal ventricular arrhythmia and received long-term calcium-blocker and nitroglycerin therapy. OUTCOMES At a 3-month follow-up, no recurrence was noted. LESSONS The lambda-like ST-elevation pattern is identified with other ST-elevation patterns by geometry and may be a new risk predictor for lethal ventricular arrhythmia on ECG. When this pattern is identified, clinicians should adopt aggressive therapeutic strategies, including ICD implantation and etiological treatment.
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Affiliation(s)
| | - Na Zhao
- Department of Rheumatology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, People's Republic of China
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35
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Iiya M, Yamawake N, Nishizaki M, Shimizu M, Fujii H, Suzuki M, Sakurada H, Hiraoka M. Ventricular Fibrillation Induced by Coronary Vasospasm in a Patient with Early Repolarization and Hyperthyroidism. Intern Med 2018; 57:3389-3392. [PMID: 30101915 PMCID: PMC6306529 DOI: 10.2169/internalmedicine.1104-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Vasospastic angina (VSA) has been recognized as a cause of ventricular fibrillation (VF) degenerating into sudden cardiac death. We experienced a case of VSA with hyperthyroidism in which VF was provoked with an augmented J-wave amplitude in the inferior leads. The patient underwent insertion of an implantable cardioverter-defibrillator for the secondary prevention of VF in addition to taking Ca-channel antagonists. He has shown no recurrence of fatal arrhythmia or anginal attack for a follow-up period of one year.
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Affiliation(s)
- Munehiro Iiya
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Japan
| | | | | | - Masato Shimizu
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Japan
| | - Hiroyuki Fujii
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Japan
| | - Makoto Suzuki
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Japan
| | - Harumizu Sakurada
- Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Japan
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36
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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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37
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Singh B, Goyal A, Mohan B, Chhabra ST, Aslam N, Wander GS. Coronary Vasospasm Abutting the Stent: A Rare Though Important Cause of Recurrent Angina. J Invasive Cardiol 2018; 30:E46-E47. [PMID: 29799427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Angiogram of the right coronary artery was used to reveal a subtotal occlusion abutting the proximal end of the stent with TIMI I flow that responded quickly to intracoronary nitrates. The patient was diagnosed with vasospastic angina.
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Affiliation(s)
- Bhupinder Singh
- Dayanand Medical College and Hospital, Udham Singh Nagar, Ludhiana 560069, India.
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38
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Sapiña-Beltrán E, Torres G, Martínez-Alonso M, Sánchez-de-la-Torre M, Franch M, Bravo C, Masa JF, Felez M, Fortuna-Gutierrez AM, Abad J, García-Río F, Drager LF, Lee Chi-Hang R, Martínez-García MÁ, Barbé F, Dalmases M. Rationale and Methodology of the SARAH Trial: Long-Term Cardiovascular Outcomes in Patients With Resistant Hypertension and Obstructive Sleep Apnea. Arch Bronconeumol 2018; 54:518-523. [PMID: 29801678 DOI: 10.1016/j.arbres.2018.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/22/2018] [Accepted: 03/24/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Patients with resistant hypertension (RH) have a high risk of developing cardiovascular events; therefore, new therapeutic approaches to better control blood pressure may be useful in improving cardiovascular outcomes. The prevalence of obstructive sleep apnea (OSA) is very high among patients with RH. Continuous positive airway pressure (CPAP) has been shown to be an effective treatment for reducing blood pressure in patients with RH. Nevertheless, the long-term effect of CPAP treatment on cardiovascular outcomes has not been explored. The main objective of the SARAH study is to assess the impact of OSA and its treatment on cardiovascular outcomes (morbidity and mortality) in patients with RH. METHODS This study is a multi-center, prospective, observational cohort study. A total of 1371 patients with RH will be enrolled in the study and followed once a year for five years. At inclusion, ambulatory blood pressure monitoring (ABPM) and a sleep study will be performed in all subjects. Socio-demographic, clinical and cardiovascular variables will be collected at baseline and follow-up. Subsequently, subjects with OSA will be managed according to local standard practice. Based on the OSA diagnosis and its treatment, three cohorts of subjects with RH will be defined: non-OSA, treated OSA and non-treated OSA. CONCLUSIONS This study will contribute to elucidating the long-term impact of OSA treatments on blood pressure control and cardiovascular outcomes in patients with RH. These results will contribute to improve the cardiovascular prognosis of patients with RH.
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Affiliation(s)
- Esther Sapiña-Beltrán
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRBLleida, Lleida, Cataluña, Spain
| | - Gerard Torres
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRBLleida, Lleida, Cataluña, Spain
| | | | - Manuel Sánchez-de-la-Torre
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRBLleida, Lleida, Cataluña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Maria Franch
- Hospital Santa Maria, Internal medicine department, Lleida, Cataluña, Spain
| | - Carmen Bravo
- Hospital Santa Maria, Internal medicine department, Lleida, Cataluña, Spain
| | - Juan F Masa
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Hospital San Pedro de Alcantara, Respiratory Dept, Caceres, Extremadura, Spain
| | - Miquel Felez
- Hospital del Mar, Unit of Sleep Breathing Disorders, Respiratory Dept, Barcelona, Cataluña, Spain
| | | | - Jorge Abad
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Hospital Universitari Germans Trias i Pujol, Respiratory Dept, Badalona, Cataluña, Spain
| | - Francisco García-Río
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Hospital Universitario La Paz-IdiPAZ, Respiratory Dept, Madrid, Spain
| | - Luciano F Drager
- University of São Paulo Medical School, Heart Institute(InCor), Sao Paulo, Brazil
| | - Ronald Lee Chi-Hang
- National University Heart Centre Singapore, Department of Cardiology, Singapore
| | - Miguel Ángel Martínez-García
- Hospital Universitario y Politécnico La Fe, Respiratory Department, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ferran Barbé
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRBLleida, Lleida, Cataluña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Mireia Dalmases
- Hospital Universitari Arnau de Vilanova and Santa Maria, Group of Translational Research in Respiratory Medicine, IRBLleida, Lleida, Cataluña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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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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Abstract
RATIONALE Vasospastic angina is caused by sudden occlusive vasoconstriction of a segment of an epicardial artery, with transient ST-segment elevation on electrocardiography. Brugada Syndrome is an inherited arrhythmogenic cardiac disorder with a diagnostic electrocardiography characterized by coved-type ST-segment elevation in right precordial leads (V1-V3). Those two diseases usually have no correlation. In this report, we discuss an interesting case of a patient who was diagnosed as vasospastic angina according to his coronary angiography, but his electrocardiography showed a Brugada-like ST-segment elevation. PATIENT CONCERNS Our patient had a 9-month history of temporary but progressive substernal burning sensation with acid bilges of shoulders and arms, as well as profuse sweating at night. DIAGNOSES Although he had no abnormal laboratory test result, no dysfunctional recorded echocardiogram or documented arrhythmia after being admitted to the hospital, his electrocardiography showed a Brugada-like ST-segment elevation. The coronary angiography result confirmed a diagnosis of vasospastic angina. INTERVENTIONS The patient was prescribed diltiazem, aspirin, isosorbide mononitrate and rosuvastatin and was strongly advised to quit cigarettes and alcohol. OUTCOMES Follow-up at half a year turned out well. LESSONS This case links Brugada syndrome to coronary vasospasm. They may share similar mechanisms. Provocation test and gene test needs to be ran to distinguish both. Long-term follow-up is essential for it may bring a warning sign for life threatening ventricular arrhythmias.
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Affiliation(s)
- Lu Yang
- Department of Cardiology, Beijing Friendship Hospital
| | - Guodong Ma
- Department of Cardiology, Beijing Friendship Hospital
| | - Tianyu Yu
- Department of Cardiology, Beijing Friendship Hospital
| | - Huikuan Gao
- Department of Cardiology, Beijing Friendship Hospital
| | | | - Yongquan Wu
- Department of Cardiology, Beijing Friendship Hospital
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China
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Malik SA, Porter TT, Pavlides G, Chatzizisis Y. Vasospastic Angina Presenting With Syncope and Chest Pain: A Case Report and Brief Literature Review. S D Med 2017; 70:498-502. [PMID: 29088521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 65-year-old male presented to the hospital with chest pain associated with recurrent syncope. He had a history of coronary artery disease and a long-standing history of smoking. While he was hospitalized, he had an episode of chest pain during which he was found to have transient ST segment elevation in the inferior leads. He was also noted to have a brief cardiac tachyarrhythmia. Coronary arteriography revealed vasospasm of the left anterior descending artery and right coronary artery, which were relieved to a significant extent after administration of intracoronary nitroglycerin. Subsequent angiograms and fractional flow reserve studies, demonstrated underlying non-obstructive coronary artery disease at the sites of spasm. No percutaneous coronary intervention was pursued. The patient was started on a calcium channel blocker on dismissal from the hospital. Upon follow up several months later, he remained free of symptoms that brought him to the hospital.
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Affiliation(s)
- Shahbaz A Malik
- Department of Internal Medicine, Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Thomas T Porter
- Department of Internal Medicine, Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Gregory Pavlides
- Department of Internal Medicine, Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Yiannis Chatzizisis
- Department of Internal Medicine, Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
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Hung MJ, Ko T, Liang CY, Kao YC. Two-dimensional myocardial deformation in coronary vasospasm-related Takotsubo cardiomyopathy: A case report of a serial echocardiographic study. Medicine (Baltimore) 2017; 96:e8232. [PMID: 28984779 PMCID: PMC5738015 DOI: 10.1097/md.0000000000008232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Although transient reduction in the left ventricular ejection fraction is characteristic of Takotsubo cardiomyopathy, little is known about the time-course changes of myocardial deformation in coronary vasospasm-related Takotsubo cardiomyopathy. PATIENT CONCERNS We retrospectively analyzed the time-course changes in left ventricle, right ventricle, and left atrium strain values in a patient with coronary vasospasm-related Takotsubo cardiomyopathy. We found that not only left ventricular strain but also left atrial strain was abnormal during acute Takotsubo cardiomyopathy due to coronary vasospasm. Right ventricular free wall strain was normal. DIAGNOSES Coronary vasospasm-related Takotsubo cardiomyopathy. INTERVENTIONS A serial echocardiographic study. OUTCOMES The left ventricular strain was still subnormal despite a normalized left ventricular ejection fraction 2 months later. The left atrial strain was normal when the left ventricular ejection fraction normalized. LESSONS From this limited experience, it is suggested that echocardiographic myocardial deformation analysis can provide more information than the standard ejection fraction in evaluating myocardial contractile function.
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Affiliation(s)
- Ming-Jui Hung
- Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ta Ko
- Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chung-Yu Liang
- Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Cheng Kao
- Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung
- Chang Gung University College of Medicine, Taoyuan, Taiwan
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Lee KH, Park HW, Eun JN, Cho JG, Yoon NS, Kim MR, Ku YH, Park H, Lee SH, Kim JH, Kim MC, Kim WJ, Kim HK, Cho JY, Park KH, Sim DS, Yoon HJ, Kim KH, Hong YJ, Kim JH, Ahn Y, Jeong MH, Park JC. Masked inherited primary arrhythmia syndromes in sudden cardiac death patients accompanied by coronary vasospasm. Korean J Intern Med 2017; 32:836-846. [PMID: 28797161 PMCID: PMC5583445 DOI: 10.3904/kjim.2015.283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/01/2015] [Accepted: 12/06/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Coronary vasospasms are one of the important causes of sudden cardiac death (SCD). Provocation of coronary vasospasms can be useful, though some results may lead to false positives, with patients potentially experiencing recurrent SCD despite appropriate medical treatments. We hypothesized that it is not coronary vasospasms but inherited primary arrhythmia syndromes (IPAS) that underlie the development of SCD. METHODS We analyzed 74 consecutive patients (3.8%) who survived out-of-hospital cardiac arrest among 1,986 patients who had angiographically proven coronary vasospasms. Electrical abnormalities were evaluated in serial follow-up electrocardiograms (ECGs) during and after the index event for a 3.9 years median follow-up. Major clinical events were defined as the composite of death and recurrent SCD events. RESULTS Forty five patients (60.8%) displayed electrocardiographic abnormalities suggesting IPAS: Brugada type patterns in six (8.2%), arrhythmogenic right ventricular dysplasia patterns in three (4.1%), long QT syndrome pattern in one (2.2%), and early repolarization in 38 (51.4%). Patients having major clinical events showed more frequent Brugada type patterns, early repolarization, and more diffuse multivessel coronary vasospasms. Brugada type pattern ECGs (adjusted hazard ratio [HR], 4.22; 95% confidence interval [CI], 1.16 to 15.99; p = 0.034), and early repolarization (HR, 2.97; 95% CI, 1.09 to 8.10; p = 0.034) were ultimately associated with an increased risk of mortality. CONCLUSIONS Even though a number of aborted SCD survivors have coronary vasospasms, some also have IPAS, which has the potential to cause SCD. Therefore, meticulous evaluations and follow-ups for IPAS are required in those patients.
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Affiliation(s)
- Ki Hong Lee
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyung Wook Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
- Correspondence to Hyung Wook Park, M.D. Department of Cardiovascular Medicine, The Heart Center of Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-62-220-6572 Fax: +82-62-223-3105 E-mail:
| | - Jeong Nam Eun
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Nam Sik Yoon
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Mi Ran Kim
- Department of Nursing, Chunnam Techno University, Gokseong, Korea
| | - Yo Han Ku
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyukjin Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Seung Hun Lee
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Han Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Woo Jin Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Kuk Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Keun-Ho Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Ju Yoon
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
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Sun J, Feng L, Li F, Zhang Y, Dong J. An interesting implantable cardioverter defibrillator treatment for lethal ventricular arrhythmias caused by coronary artery spasm: A case report. Medicine (Baltimore) 2017; 96:e7251. [PMID: 28658116 PMCID: PMC5500038 DOI: 10.1097/md.0000000000007251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Coronary artery spasm (CAS) could cause serious lethal ventricular arrhythmias. While implantable cardioverter defibrillators (ICDs) have been recommend for secondary prevention of sudden cardiac death related to lethal ventricular arrhythmias. However, in resuscitated sudden cardiac death caused by CAS, the effect of ICD is still not well clear. PATIENT CONCERNS A 60-year-old male presented with 2 episodes of syncope. Coronary angiography showed normal coronary arteries. Twenty-four hour Holter electrocardiograms revealed that there were repeatedly transient marked ST segment elevation in the all leads except avR lead, junctional rhythm, and subsequently nonsustained ventricular tachycardia. DIAGNOSES Ischemic-induced lethal ventricular arrhythmias caused by CAS. INTERVENTIONS Both calcium channel blocker (diltiazem, 180 mg twice daily) and nitrate (isosorbide dinitrate 40 mg twice daily) were initially administrated, and ICD was subsequently implanted as a secondary prevention. OUTCOMES In the early stage of CAS, ICD therapy terminated the lethal ventricular arrhythmias. Conversely, after the administration of epinephrine, ICD therapy, even combined with external defibrillation, failed in resuscitating sudden cardiac death. LESSONS For the sudden cardiac death related to lethal ventricular arrhythmias caused by CAS, ICD therapy is an efficient secondary prevention base on administrating coronary vasodilators. Furthermore, administration of epinephrine should be avoided during cardiorespiratory resuscitation of sudden cardiac death caused by CAS.
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Braam B, Taler SJ, Rahman M, Fillaus JA, Greco BA, Forman JP, Reisin E, Cohen DL, Saklayen MG, Hedayati SS. Recognition and Management of Resistant Hypertension. Clin J Am Soc Nephrol 2017; 12:524-535. [PMID: 27895136 PMCID: PMC5338706 DOI: 10.2215/cjn.06180616] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Despite improvements in hypertension awareness and treatment, 30%-60% of hypertensive patients do not achieve BP targets and subsequently remain at risk for target organ damage. This therapeutic gap is particularly important to nephrologists, who frequently encounter treatment-resistant hypertension in patients with CKD. Data are limited on how best to treat patients with CKD and resistant hypertension, because patients with CKD have historically been excluded from hypertension treatment trials. First, we propose a consistent definition of resistant hypertension as BP levels confirmed by both in-office and out-of-office measurements that exceed appropriate targets while the patient is receiving treatment with at least three antihypertensive medications, including a diuretic, at dosages optimized to provide maximum benefit in the absence of intolerable side effects. Second, we recommend that each patient undergo a standardized, stepwise evaluation to assess adherence to dietary and lifestyle modifications and antihypertensive medications to identify and reduce barriers and discontinue use of substances that may exacerbate hypertension. Patients in whom there is high clinical suspicion should be evaluated for potential secondary causes of hypertension. Evidence-based management of resistant hypertension is discussed with special considerations of the differences in approach to patients with and without CKD, including the specific roles of diuretics and mineralocorticoid receptor antagonists and the current place of emerging therapies, such as renal denervation and baroreceptor stimulation. We endorse use of such a systematic approach to improve recognition and care for this vulnerable patient group that is at high risk for future kidney and cardiovascular events.
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Affiliation(s)
- Branko Braam
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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47
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Khan HR, Aslam S. Blocked Coronary Artery Due To Coronary Spasm Treated With Stent Insertion: A Sub-Optimal Result? J Ayub Med Coll Abbottabad 2017; 29:142-144. [PMID: 28712194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Myocardial infarction (MI) is an extremely common cause of chest pain. MI can be acute with ST elevation (STEMI) or non-STEMI (NSTEMI). Coronary artery spasm can be severe enough to cause occlusion of the coronary arteries particularly with an exaggerated response in regions of coronary atheroma and plaque ulceration. It is not uncommon for coronary spasm to be mistaken with acute thrombotic occlusion of the coronary artery. We describe a case of a 42-year old man with known cardiac risk factors presents with chest pain for few hours to a tertiary centre hospital. A coronary angiogram showed occlusion of the right epicardial coronary artery with a severe spasm at the level of the atheroma. The initial coronary stent which was deformed because of intense pressure of spasm required another stent to be placed within the first stent. Diltiazem and Nitrates were started as secondary prevention treatment to reduce effect of coronary spasm. The patient made an uneventful recovery and was discharged home with no sequelae over the next 3 years follow up.
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Affiliation(s)
- Habib Rehman Khan
- Cardiology Department, Nottingham University Hospitals, Manchester Royal Infirmary, Manchester, UK
| | - Sajid Aslam
- Cardiology Department, Nottingham University Hospitals, Manchester Royal Infirmary, Manchester, UK
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Kujime S, Sakurada H, Saito N, Enomoto Y, Ito N, Nakamura K, Fukamizu S, Tejima T, Yambe Y, Nishizaki M, Noro M, Hiraoka M, Sugi K. Outcomes of Brugada Syndrome Patients with Coronary Artery Vasospasm. Intern Med 2017; 56:129-135. [PMID: 28090040 PMCID: PMC5337455 DOI: 10.2169/internalmedicine.56.7307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the outcomes of patients with concomitant Brugada syndrome and coronary artery vasospasm. Methods Patients diagnosed with Brugada syndrome with an implantable cardiac defibrillator were retrospectively investigated, and the coexistence of vasospasm was evaluated. The clinical features and outcomes were evaluated, especially in patients with coexistent vasospasm. A provocation test using acetylcholine was performed in patients confirmed to have no organic stenosis on percutaneous coronary angiography to confirm the presence of vasospasm. Implantable cardiac defibrillator shock status was checked every three months. Statistical comparisons of the groups with and without vasospasm were performed. A univariate analysis was also performed, and the odds ratio for the risk of implantable cardiac defibrillator shock was calculated. Patients Thirty-five patients with Brugada syndrome, of whom six had coexistent vasospasm. Results There were no significant differences in the laboratory data, echocardiogram findings, disease, or the history of taking any drugs between patients with and without vasospasm. There were significant differences in the clinical features of Brugada syndrome, i.e. cardiac events such as resuscitation from ventricular fibrillation or appropriate implantable cardiac defibrillator shock. Four patients with vasospasm had cardiac events such as resuscitation from ventricular fibrillation and/or appropriate defibrillator shock; three of them had no cardiac events with calcium channel blocker therapy to prevent vasospasm. The coexistence of vasospasm was a potential risk factor for an appropriate implantable cardiac defibrillator shock (odds ratio: 13.5, confidence interval: 1.572-115.940, p value: 0.035) on a univariate analysis. Conclusion Coronary artery vasospasm could be a risk factor for cardiac events in patients with Brugada syndrome.
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Affiliation(s)
- Shingo Kujime
- Department of Cardiology, Yokohama General Hospital, Japan
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Sueda S, Kohno H, Yoshino H. The real world in the clinic before and after the establishment of guidelines for coronary artery spasm: a questionnaire for members of the Japanese Cine-angio Association. Heart Vessels 2016; 32:637-643. [PMID: 27921167 DOI: 10.1007/s00380-016-0916-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 10/31/2016] [Indexed: 01/22/2023]
Abstract
We investigated the clinical situations and the present knowledge of Japanese cardiologists about coronary artery spasm before and after the establishment of guidelines for this condition in the real world. A questionnaire was developed regarding the number of cases of coronary angiography, percutaneous coronary intervention, and invasive/non-invasive spasm provocation tests before (2008) and after (2014) the establishment of the Japanese Circulation Society (JCS) guidelines for coronary artery spasm and the status of spasm provocation tests. The questionnaire was sent to members of the Japanese Cine-angio Association in 81 cardiology hospitals in Japan. The completed surveys were returned from 20 hospitals, giving a response rate of 24.7%. Pharmacological spasm provocation tests increased in 2014 and vasospastic angina and variant angina also increased in 2014 compared with 2008, but the increase was not significant. Non-invasive spasm provocation tests such as hyperventilation tests and cold stress tests decreased remarkably in 2014. Spasm provocation tests were initially performed in the left coronary artery was employed in just 30% of the hospitals. The majority of institutions did not perform the spasm provocation testing in patients with unknown causes of heart failure or in survivors of ventricular fibrillation. Although 40% of the hospitals were not satisfied with standard spasm provocation tests, the majority of the hospitals agreed that spasm provocation tests will be necessary in the future. In general, the JCS guidelines contributed to the widespread use of provocative testing for coronary artery spasm in the real world. However, some issues about spasm still remained in the clinic.
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Affiliation(s)
- Shozo Sueda
- Department of Cardiology, Ehime Prefectural Niihama Hospital, Hongou 3 Choume 1-1, Niihama City, Ehime, 792-0042, Japan.
| | - Hiroaki Kohno
- Department of Cardiology, Tsukazaki Hospital, Himeji, Japan
| | - Hideaki Yoshino
- Department of Cardiology, Kyorin University Hospital, Tokyo, Japan
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50
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Abstract
This study reports 2 cases of severe coronary artery spasm with anaphylactoid shock caused by contrast medium. The first patient had anaphylactoid shock in response to contrast medium and severe coronary spasms of both the left anterior descending coronary artery and the left circumflex coronary artery. The patient developed ventricular arrhythmia and complete atrioventricular block following the severe coronary spasm. The second patient had a totally occluded right coronary artery, owing to a spasm after anaphylactoid shock. Anaphylactoid shock should always be considered when persistent shock is noted after the coronary artery spasm has been relieved.
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Affiliation(s)
- Charles Chao-Yung Wang
- Second Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
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