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Boivin-Proulx LA, Marquis-Gravel G, Rousseau-Saine N, Harel F, Jolicoeur EM, Pelletier-Galarneau M. Hyperventilation testing in the diagnosis of vasospastic angina: A clinical review and meta-analysis. Eur J Clin Invest 2024; 54:e14178. [PMID: 38348627 DOI: 10.1111/eci.14178] [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: 12/15/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND Given the limited access to invasive vasospastic reactivity testing in Western Countries, there is a need to further develop alternative non-invasive diagnostic methods for vasospastic angina (VSA). Hyperventilation testing (HVT) is defined as a class IIa recommendation to diagnose VSA by the Japanese Society of Cardiology. METHODS In this systematic review and meta-analysis reported according to the PRISMA statement, we review the mechanisms, methods, modalities and diagnostic accuracy of non-invasive HVT for the diagnostic of VSA. RESULTS A total of 106 articles published between 1980 and 2022 about VSA and HVT were included in the systematic review, among which 16 were included in the meta-analysis for diagnostic accuracy. Twelve electrocardiogram-HVT studies including 804 patients showed a pooled sensitivity of 54% (95% confidence intervals [CI]; 30%-76%) and a pooled specificity of 99% (95% CI; 88%-100%). Four transthoracic echocardiography-HVT studies including 197 patients revealed a pooled sensitivity of 90% (95% CI; 82%-94%) and a pooled specificity of 98% (95% CI; 86%-100%). Six myocardial perfusion imaging-HVT studies including 112 patients yielded a pooled sensitivity of 95% (95% CI; 63%-100%) and a pooled specificity of 78% (95% CI; 19%-98%). Non-invasive HVT resulted in a low rate of adverse events, ventricular arrhythmias being the most frequently reported, and were resolved with the administration of nitroglycerin. CONCLUSIONS Non-invasive HVT offers a safe alternative with high diagnostic accuracy to diagnose VSA in patients with otherwise undiagnosed causes of chest pain.
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Affiliation(s)
| | | | | | - François Harel
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - E Marc Jolicoeur
- CHUM Research Center and Cardiovascular Center, Montreal, Quebec, Canada
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2
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Mohajeri M, Cicero AFG. Dietary inflammation index association with serum levels of nitric oxide, prostacyclin, and thromboxane B2 among prinzmetal angina patients and healthy persons. Nutr Metab Cardiovasc Dis 2024; 34:1054-1060. [PMID: 38233271 DOI: 10.1016/j.numecd.2023.11.018] [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: 06/15/2023] [Revised: 11/04/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND AND AIM This study aimed to assess the association between dietary inflammation index with serum Nitric oxide, Prostacyclin, and Thromboxane B2 among Prinzmetal angina patients and healthy persons. METHODS AND RESULTS This case-control study was conducted among 120 Prinzmetal angina patients and 120 healthy persons referred to the Ardabil Imam Khomeini Hospital between 2021 and 2022. Blood samples were gained from all study participants for measurement of serum Nitric oxide, Prostacyclin, and Thromboxane B2. The serum Nitric oxide in patients who had higher DII was less than in patients with less dietary inflammation index (β = -0.75 p = 0.02). The serum Prostacyclin level in patients with greater dietary inflammation index was 0.68 ng/ml less than in patients with less dietary inflammation index (β = -0.68 p = 0.04). The level of serum Thromboxane B2 had a positive association with dietary inflammation index (β = 0.81 p = 0.04). CONCLUSION In Prinzmetal angina patients, more dietary inflammation index can increase the serum Thromboxane B2 and decrease the serum Nitric oxide and Prostacyclin. More clinical trial study is needed to confirm these results.
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Affiliation(s)
- Mahsa Mohajeri
- Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Arrigo F G Cicero
- Hypertension and Cardiovascular Risk Research Group, Medicine and Surgery Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy; Cardiovascular Medicine Unit, IRCCS AOUBO, 40138 Bologna, Italy.
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3
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Picard F, Adjedj J, Collet JP, Van Belle E, Monsegu J, Karsenty B, Dupouy P, Quillot M, Bonnet G, Gautier A, Cayla G, Benamer H. Pharmacological coronary spasm provocative testing in clinical practice: A French Coronary Atheroma and Interventional Cardiology Group (GACI) position paper. Arch Cardiovasc Dis 2023; 116:590-596. [PMID: 37891058 DOI: 10.1016/j.acvd.2023.10.002] [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: 08/28/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023]
Abstract
Vasospastic angina, also described as Prinzmetal angina, was first described as a variant form of angina at rest with transient ST-segment elevation; it is common and present in many clinical scenarios, including chronic and acute coronary syndromes, sudden cardiac death, arrhythmia and syncope. However, vasospastic angina remains underdiagnosed, and provocative tests are rarely performed. The gold-standard diagnostic approach uses invasive coronary angiography to induce coronary spasm using ergonovine, methylergonovine or acetylcholine as provocative stimuli. The lack of uniform protocol decreases the use and performance of these tests, accounting for vasospastic angina underestimation. This position paper from the French Coronary Atheroma and Interventional Cardiology Group (GACI) aims to review the indications for provocative tests, the testing conditions, drug protocols and positivity criteria.
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Affiliation(s)
- Fabien Picard
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, AP-HP, 75014 Paris, France.
| | - Julien Adjedj
- Department of Cardiology, Institut Arnault-Tzanck, 06700 Saint-Laurent-du-Var, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, AP-HP, 75013 Paris, France
| | - Eric Van Belle
- CHU Lille, Department of Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Coeur Poumon, INSERM U1011, Institut Pasteur de Lille, EGID, Université de Lille, 59000 Lille, France
| | - Jacques Monsegu
- Department of Interventional Cardiology, Institut Cardio-Vasculaire, Groupe Hospitalier Mutualiste Grenoble, 38000 Grenoble, France
| | | | - Patrick Dupouy
- Pôle Cardio-Vasculaire Interventionnel, Clinique les Fontaines, 77000 Melun, France
| | - Marine Quillot
- Department of Interventional Cardiology, Centre Hospitalier Henri-Duffaut, 84000 Avignon, France
| | - Guillaume Bonnet
- Haut-Lévêque Cardiology Hospital, Bordeaux University, 33600 Pessac, France
| | - Alexandre Gautier
- Department of Cardiology, Hôpital Bichat, AP-HP, 75018 Paris, France
| | - Guillaume Cayla
- Cardiology Department, Nîmes University Hospital, Montpellier University, 30900 Nîmes, France
| | - Hakim Benamer
- ICPS Jacques Cartier, Ramsay Générale de Santé, 91300 Massy, France; ICV-GVM La Roseraie, 93300 Aubervilliers, France; Hôpital Foch, 92150 Suresnes, France
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4
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Mattia D, Matney C, Zangwill S, Wisotzkey B, Rhee E, Knoll C. Prinzmetal angina in a child with actin gene ACTC1 mutation. Cardiol Young 2023; 33:2440-2442. [PMID: 37489518 DOI: 10.1017/s1047951123002640] [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: 07/26/2023]
Abstract
Prinzmetal angina is a rare cause of intermittent chest pain in paediatrics. Here, we report the case of a 2-year-old female who presented with episodic chest pain, malaise, diaphoresis, fatigue, and poor perfusion on exam. During her hospitalisation, these episodes were associated with significant low cardiac output as evidenced by lactic acidosis and low mixed venous oxygen saturations. Her workup revealed an actin alpha cardiac muscle 1 (ACTC1) gene mutation and associated left ventricular non-compaction with decreased systolic function. She was started on oral heart failure medications as well as a calcium channel blocker but continued to have episodes which were found to promptly resolve with nitroglycerine. She was ultimately listed for cardiac transplant given her perceived risk of sudden death.
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Affiliation(s)
- Donald Mattia
- Phoenix Children's Center for Heart Care, Phoenix, AZ, USA
| | - Chelsea Matney
- Phoenix Children's Center for Heart Care, Phoenix, AZ, USA
| | | | | | - Edward Rhee
- Phoenix Children's Center for Heart Care, Phoenix, AZ, USA
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5
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Mohajeri M, Cicero AFG. Adherence to the Mediterranean Diet Association with Serum Levels of Nitric Oxide, Prostacyclin, and Thromboxane B 2 among Prinzmetal Angina Patients and Healthy Persons. Nutrients 2023; 15:nu15030738. [PMID: 36771443 PMCID: PMC9919954 DOI: 10.3390/nu15030738] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/31/2022] [Revised: 01/21/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
This study aimed to assess the association between adherence to the Mediterranean diet with serum Nitric oxide, Prostacyclin, and Thromboxane B2 among Prinzmetal angina patients and healthy persons. This case-control study was conducted among 100 Prinzmetal angina patients and 100 healthy persons referred to the Ardabil Imam Khomeini hospital between 2021 and 2022. Blood samples were obtained from all study participants for measurement of serum Nitric oxide, Prostacyclin, and Thromboxane B2. To calculate adherence to the Mediterranean diet, the ten-item screener was used. The serum Nitric oxide in patients who adhered more to the Mediterranean diet was higher than patients with less adherence (coeff. = 0.41 p = 0.04). The serum Prostacyclin level in patients with greater adherence to the Mediterranean diet was 0.34 units higher than patients with less adherence (coeff. = 0.34 p = 0.02). The level of serum Thromboxane B2 had a negative association with adherence to the Mediterranean diet (coeff. = -0.48 p = 0.04). The amount of consumption of olive oil, fruits, vegetables, and legumes in healthy people was more than Prinzmetal angina patients. In Prinzmetal angina patients, more adherence to the Mediterranean diet can decrease the serum Thromboxane B2 and increase the serum Nitric oxide and Prostacyclin.
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Affiliation(s)
- Mahsa Mohajeri
- Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil 56131-56491, Iran
- Correspondence: or mahsa. (M.M.); (A.F.G.C.); Tel.: +98-9143592794 (M.M.); +39-512142224 (A.F.G.C.)
| | - Arrigo F. G. Cicero
- Medicine and Surgery Sciences Department, Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
- IRCCS AOU S. Orsola-Malpighi University Hospital, 40123 Bologna, Italy
- Correspondence: or mahsa. (M.M.); (A.F.G.C.); Tel.: +98-9143592794 (M.M.); +39-512142224 (A.F.G.C.)
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6
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Belfar AL, Deng Y, Yu RC, Sabbagh A. Successful Use of Continuous Erector Spinae Plane Blocks in a Patient With Variant Angina After Large Ventral Hernia Repair. Tex Heart Inst J 2022; 49:489335. [PMID: 36534113 PMCID: PMC9809071 DOI: 10.14503/thij-21-7624] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Coronary artery spasm constitutes the primary underlying pathology of variant angina. Because provocation of coronary artery spasm may occur with both excess sympathetic and excess parasympathetic stimulation, patients with this disorder have extremely limited options for perioperative pain control. This is especially true for procedures involving extensive abdominal incision/manipulation. Whereas neuraxial analgesia might otherwise be appropriate in these cases, several studies have demonstrated that coronary artery spasm can occur as a result of epidural placement, and therefore, that this may not be an optimal choice for patients with variant angina. This report discusses the case of a patient with a preexisting diagnosis of variant angina who underwent an exploratory laparotomy with large ventral hernia repair and for whom continuous erector spinae plane blocks were successfully used as analgesic adjuncts without triggering coronary artery spasm.
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Affiliation(s)
| | - Yi Deng
- Department of Anesthesiology, Baylor College of Medicine, Houston, Texas
| | - Raymond C. Yu
- Department of Anesthesiology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Annas Sabbagh
- Department of Anesthesiology, Allegheny Health Network, Pittsburgh, Pennsylvania
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7
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Teperikidis E, Boulmpou A, Charalampidis P, Tsavousoglou C, Giannakoulas G, Papadopoulos CE, Vassilikos V. 5-Fluorouracil, capecitabine and vasospasm: a scoping review of pathogenesis, management options and future research considerations. Acta Cardiol 2022; 77:1-13. [PMID: 33683181 DOI: 10.1080/00015385.2021.1873548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND 5-Fluorouracil (5-FU) is a widely used chemotherapeutic agent that can cause cardiotoxicity manifesting, among others, as chest pain. Capecitabine is an oral prodrug of 5-FU, with reported preferential activation in malignant cells that may also cause cardiotoxic reactions. Standard treatment of 5-FU and capecitabine induced chest pain with vasodilators is mostly effective, but there are several cases of patients unresponsive to these agents. METHODS We performed a PubMed search on 31st May 2020. We used a three keyword search strategy using Boolean search operators. More specifically, we included fluorouracil or 5-FU or capecitabine and chest pain or angina and mechanism or treatment or management. We included primary reports of clinical and non-clinical data, as well as systematic reviews. Narrative reviews, expert opinions, letters to the editor and other forms of non-primary literature were excluded. RESULTS Our search yielded a total of 1595 reports. Of these, 1460 were narrative reviews or irrelevant to the topic and were excluded. A total of 135 reports were used for our review. We used 81 reports for data extraction, which included 13 clinical trials, 4 retrospective reports, 61 case reports, and 3 systematic reviews. CONCLUSION We report the incidence and predisposing factors, the value of available diagnostic procedures, and standard medical and invasive treatments. We also speculate on the potential benefit of arginine as a promising option both in prevention as well as treatment of 5-FU-induced chest pain. Finally, gaps of evidence are identified and proposals are made in terms of future research.
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Affiliation(s)
- Eleftherios Teperikidis
- Third Department of Cardiology, Ιppokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristi Boulmpou
- Third Department of Cardiology, Ιppokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Charalampidis
- Third Department of Cardiology, Ιppokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- St Luke’s Hospital, Thessaloniki, Greece
| | - Chalil Tsavousoglou
- Third Department of Cardiology, Ιppokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E. Papadopoulos
- Third Department of Cardiology, Ιppokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios Vassilikos
- Third Department of Cardiology, Ιppokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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8
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Abstract
Coronary artery vasospasm (CAVS) plays an important role in acute chest pain syndrome caused by transient and partial or complete occlusion of the coronary arteries. Pathophysiology of the disease remains incompletely understood, with autonomic and endothelial dysfunction thought to play an important role. Due to the dynamic nature of the disease, its exact prevalence is not entirely clear but is found to be more prevalent in East Asian and female population. Cigarette smoking remains a prominent risk factor, although CAVS does not follow traditional coronary artery disease risk factors. Many triggers continue to be identified, with recent findings identifying chemotherapeutics, allergens, and inflammatory mediators as playing some role in the exacerbation of CAVS. Provocative testing with direct visualization is currently the gold-standard for diagnosis, but non-invasive tests, including the use of biomarkers, are being increasingly studied to aid in the diagnosis. Treatment of the CAVS is an area of active research. Apart from risk factor modification, calcium channel blockers are currently the first line treatment, with nitrates playing an important adjunct role. High-risk patients with life-threatening complications should be considered for implantable cardioverter defibrillator (ICD), although timing criteria for escalated therapy require further investigation. The role of pharmaceuticals targeting oxidative stress remains incompletely understood.
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Affiliation(s)
- Jacob Jewulski
- Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, United States
| | - Sumesh Khanal
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073, United States
| | - Khagendra Dahal
- Department of Cardiology, CHI Health, Creighton University School of Medicine, Omaha, NE 68118, United States
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9
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Sheth MA, Widmer RJ, Dandapantula HK. Pathobiology and evolving therapies of coronary artery vasospasm. Proc (Bayl Univ Med Cent) 2021; 34:352-360. [PMID: 33953459 DOI: 10.1080/08998280.2021.1898907] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Coronary artery vasospasm is a known cause of chest pain and requires a high level of clinical suspicion for diagnosis. It also remains in the differential diagnosis for patients presenting with type 2 myocardial infarction. There are few randomized controlled trials for guideline-based prevention and treatment for coronary artery vasospasm. In this article, we review updated concepts in coronary artery vasospasm. Specifically, our aim is to provide current evidence of pathophysiology, identify the risk factors, propose a diagnostic algorithm, review available evidence of evolving therapies, and identify patients who would benefit from automatic implantable cardioverter defibrillators.
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Affiliation(s)
- Monish A Sheth
- Division of Hospital Medicine, Department of Internal Medicine, Baylor Scott & White Medical Center, Temple, Texas
| | - Robert J Widmer
- Division of Cardiology, Department of Internal Medicine, Baylor Scott & White Medical Center, Temple, Texas
| | - Hari K Dandapantula
- Division of Cardiology, Department of Internal Medicine, Baylor Scott & White Medical Center, Temple, Texas
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10
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Patel KH, Doodnauth AV, Dunkley JC, Abrams J, McFarlane SI. Aborted Sudden Cardiac Death from Vasospastic-Induced Ventricular Fibrillation with Normal Coronary Angiography: A Case Report and Review of the Literature. Am J Med Case Rep 2021; 9:78-82. [PMID: 33365388 DOI: 10.12691/ajmcr-9-1-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Coronary artery vasospasms have been known to cause episodic angina pectoris, along with ST-T wave changes. In addition, vasospasm if prolonged can cause myocardial ischemia leading to malignant arrhythmias such as ventricular fibrillation and ventricular tachycardia resulting in sudden cardiac death (SCD). Treatment for this disorder can be challenging. Current data is lacking on the management of patients receiving appropriate vasodilator medications who present with Ventricular Fibrillation (VFib) as a consequence of coronary artery vasospasms. We present a case of a 71-year-old man who was hospitalized due to recurrent episodes of coronary vasospasms leading to acute decompensation and VFib with subsequent resuscitation while undergoing cardiac catheterization. We also provide review of the literature and updates on the current guidelines from the American Heart Association on this potentially life-threatening disorder.
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11
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Dahdouh Z, Mohamed T. Prinzmetal Angina Mimicking Severe Three-Vessel Coronary Artery Disease. J Invasive Cardiol 2020; 32:E240-E241. [PMID: 32865511] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Coronary artery vasospasm, or Prinzmetal angina, remains a challenging diagnosis. Prinzmetal angina usually affects only one coronary vessel; however, in this case, it occurred simultaneously in three coronary arteries, and was totally relieved after nitrate administration.
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Affiliation(s)
- Ziad Dahdouh
- Heart Center, King Faisal Specialist Hospital & Research Center, Zahrawi St, Al Maather, Al Maazer, Riyadh 12713, Saudi Arabia.
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12
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Elbadawi A, Elgendy IY, Naqvi SY, Mohamed AH, Ogunbayo GO, Omer MA, Mentias A, Saad M, Abbott JD, Jneid H, Bhatt DL. Temporal Trends and Outcomes of Hospitalizations With Prinzmetal Angina: Perspectives From a National Database. Am J Med 2019; 132:1053-1061.e1. [PMID: 31047867 DOI: 10.1016/j.amjmed.2019.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Contemporary data regarding the temporal changes in prevalence and outcomes of hospitalizations with Prinzmetal angina are limited. METHODS We queried the National Inpatient Sample Database for the years 2002-2015 to identify hospitalizations with Prinzmetal angina. We described the temporal trends and outcomes in patients with Prinzmetal angina. RESULTS A total of 97,280 hospitalizations with Prinzmetal angina were identified. There was a significant increase in the number of hospitalizations with Prinzmetal angina (3678 in 2002 vs 8633 in 2015, Ptrend <.001) as well as the proportion of hospitalizations with Prinzmetal angina among those with chest pain (Ptrend <.001). There was an increase in the rates of in-hospital mortality (0.24% in 2002 vs 0.85% in 2015, Ptrend = .02), which corresponded to a progressive increase in the burden of comorbidities among patients with Prinzmetal angina. Age >65 years, history of heart failure, chronic kidney disease, chronic liver disease, and acute myocardial infarction upon presentation were independent predictors of in-hospital mortality. Compared with patients with acute myocardial infarction without Prinzmetal angina, those with Prinzmetal angina presenting with acute myocardial infarction had a lower incidence of in-hospital mortality (odds ratio 0.24, 95% confidence interval 0.14-0.41). CONCLUSIONS In this large national analysis, there has been an increase in the prevalence of hospitalizations with Prinzmetal angina. Older age, heart failure, chronic kidney disease, chronic liver disease, and acute myocardial infarction were predictors of higher mortality among patients with Prinzmetal angina. Patients with Prinzmetal angina who developed acute myocardial infarction had more favorable outcomes compared with myocardial infarction without Prinzmetal angina.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville
| | - Syed Yaseen Naqvi
- Division of Cardiovascular Medicine, University of Rochester, Rochester, N.Y
| | - Ahmed H Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, N.Y
| | | | - Mohamed A Omer
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City
| | - Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa, Iowa City
| | - Marwan Saad
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - J Dawn Abbott
- Division of Cardiovascular Medicine, Warren Alpert School of Medicine at Brown University, Providence, R.I
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, Tex
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass.
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Baghdasaryan L. A 16-year-old boy with bronchial asthma and prinzmetal angina: case report. Eur Heart J Case Rep 2018; 2:yty042. [PMID: 31020122 PMCID: PMC6177102 DOI: 10.1093/ehjcr/yty042] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 11/15/2022]
Abstract
Introduction Prinzmetal’s angina is a very rare disease in children and adolescents. Adults’ studies suggest that vasospastic angina is more common in patients with bronchial asthma than in the general population. Case presentation A 16-year-old boy with a history of bronchial asthma was admitted to the hospital after successful resuscitation from asystole. On the day of admission, he had a severe left shoulder pain and developed cardiac arrest. He was complaining of left shoulder pain throughout the previous year. During his hospital stay, a second cardiac arrest took place with inferior ST elevation of the electrocardiography recorded after the second successful resuscitation. Diagnostic coronary angiography revealed multiple spasms throughout the coronary bed, which was completely resolved after intracoronary nitroglycerine administration. The patient was diagnosed Printzmetal’s vasospasic angina, and the symptoms disappeared gradually with up-titration of a calcium channel blocker and a nitrate. Discussion Previous studies have suggested that the pathogenesis of Prinzmetal’s vasospastic angina may be similar to that of bronchial asthma, as we see in the presentation of this young patient.
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14
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Ben-Yakov M, Mattu A, Brady WJ, Dubbs SB. Prinzmetal angina (Coronary vasospasm) associated with 5-fluorouracil chemotherapy. Am J Emerg Med 2017; 35:1038.e3-5. [PMID: 28283339 DOI: 10.1016/j.ajem.2017.02.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 02/25/2017] [Indexed: 11/20/2022] Open
Abstract
Several chemotherapeutic agents are known to be cardiotoxic. One of them, 5-fluorouracil (5-FU), has been associated with coronary ischemia and reversible vasospasm. In this report, we describe a 54-year-old man with rectal cancer who developed chest pain during 5-FU infusion. His initial electrocardiogram (ECG), obtained while he was experiencing chest pain, showed hyperacute T waves in the anterolateral leads. Those waves disappeared along with the chest pain after administration of sublingual nitroglycerine. An urgent coronary angiogram revealed that the patient had no significant flow-limiting coronary artery disease to account for this chest pain. The final diagnosis was coronary artery spasm with moderate global left ventricular dilatation suggestive of nonischemic cardiomyopathy. During 3days of hospitalization, the patient remained pain free and therefore was discharged. To our knowledge, this is the first case report in the emergency medicine literature demonstrating a coronary vasospastic event associated with 5-FU cardiac toxicity.
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Shin ES, Ann SH, Singh GB, Lim KH, Yoon HJ, Hur SH, Her AY, Koo BK, Akasaka T. OCT-Defined Morphological Characteristics of Coronary Artery Spasm Sites in Vasospastic Angina. JACC Cardiovasc Imaging 2015; 8:1059-1067. [PMID: 26298073 DOI: 10.1016/j.jcmg.2015.03.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 03/10/2015] [Accepted: 03/19/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this study was to define the morphological features of coronary artery spasm sites using optical coherence tomography (OCT) in patients with vasospastic angina (VSA). BACKGROUND Plaque characteristics at coronary artery spasm sites have not been investigated systematically. METHODS Sixty-nine consecutive patients (80 spasm sites) presenting with VSA who underwent OCT imaging were included in this study. Fibrous cap disruption was identified by the discontinuation of fibrous cap with or without intraplaque cavity formation. OCT-defined erosion was established by the presence of thrombus with or without lumen irregularity overlying an intact fibrous cap on multiple adjacent OCT frames. Other morphological features such as the absence of thrombus with or without lumen irregularity and those not in the previously mentioned criteria were also documented. RESULTS Plaque was seen on OCT in 79 of the 80 spasm sites. Fibrous cap disruption was detected at 3 sites (4%). OCT-defined erosion was observed at 21 spasm sites (26%). Thrombus with lumen irregularity was observed in 20 sites, whereas 1 site had thrombus without lumen irregularity. Lumen irregularity without thrombus was observed at 49 spasm sites (61%). Spontaneous spasm was seen more frequently in patients with acute myocardial infarction and out-of-hospital cardiac arrest than in patients without these conditions (50.0% vs. 19.3%, p = 0.025). CONCLUSIONS Our results show that OCT-defined erosion at spasm sites occurred in more than one-fourth of patients in this study. Luminal irregularity was observed in nearly two-thirds of the patients without overlying thrombus. These findings suggest the potential role of antiplatelet therapy in VSA.
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Affiliation(s)
- Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
| | - Soe Hee Ann
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Gillian Balbir Singh
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Kyung Hun Lim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Hyuck-Jun Yoon
- Department of Cardiology, Keimyung University, Dongsan Medical Center, Daegu, South Korea
| | - Seung-Ho Hur
- Department of Cardiology, Keimyung University, Dongsan Medical Center, Daegu, South Korea
| | - Ae-Young Her
- Department of Cardiology, Kangwon National University, Chuncheon, South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan
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Farah A, Ohlow MA, Kühn B, Frommhold M, Lotze U, Christoph Geller J, Lauer B. A case of Prinzmetal angina diagnosed by Holter monitoring who survived a sudden cardiac death: Case report. J Cardiol Cases 2012; 6:e88-e90. [PMID: 30533079 PMCID: PMC6269253 DOI: 10.1016/j.jccase.2012.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 05/14/2012] [Accepted: 06/01/2012] [Indexed: 11/30/2022] Open
Abstract
A 47-year-old female patient was admitted to our hospital after a syncope. She reported episodes of angina in previous weeks. On admission, there were no electrocardiographic changes but elevated troponin. Coronary angiogram showed minimal arteriosclerosis and normal left ventricle. Holter monitoring showed severe ST-segment changes during an anginal episode.With calcium antagonists, the patient experienced no further episodes of angina or ST changes during telemetry.Six weeks later, calcium antagonist was stopped for unknown reason. After that, the patient experienced a second prolonged syncope with cardiopulmonary resuscitation and defibrillation of ventricular fibrillation. DISCUSSION "A variant form of angina pectoris" was first described by Myron Prinzmetal. He postulated coronary vasospasm as the underlying cause, however, after 50 years the exact pathophysiology is still not known.Patients with "variant angina" usually present with "spontaneous" attacks of typical retrosternal anginal pain during rest or normal activities, but not with physical exercise.Sudden cardiac deaths were reported in patients with Prinzmetal angina in only a few case reports. CONCLUSION In cases of variant angina accompanied by syncope, a provocation test and an electrophysiological study should be considered.
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Affiliation(s)
- Ahmed Farah
- Department of Cardiology, Zentralklinik, Robert Koch Allee 7, 99437 Bad Berka, Germany
| | - Marc-Alexander Ohlow
- Department of Cardiology, Zentralklinik, Robert Koch Allee 7, 99437 Bad Berka, Germany
| | - Bettina Kühn
- Department of Cardiology, Zentralklinik, Robert Koch Allee 7, 99437 Bad Berka, Germany
| | - Markus Frommhold
- Department of Cardiology, Zentralklinik, Robert Koch Allee 7, 99437 Bad Berka, Germany
| | - Ulrich Lotze
- Department of Internal Medicine, DRK Krankenhaus Sondershausen, Hospitalstraße 2, 99706, Sondershausen, Germany
| | | | - Bernward Lauer
- Department of Cardiology, Zentralklinik, Robert Koch Allee 7, 99437 Bad Berka, Germany
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Angelini P, Uribe C, Lozano P. Differential local spasticity in myocardial bridges. Tex Heart Inst J 2012; 39:384-388. [PMID: 22719149 PMCID: PMC3368448] [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: 06/01/2023]
Abstract
To illustrate the effect of myocardial bridges on coronary vascular tone, we describe the cases of 2 patients with different clinical presentations in the context of reproducible increased spasticity at the site of myocardial bridging. One had an episode of takotsubo cardiomyopathy, and one developed typical Prinzmetal angina while receiving desmopressin treatment for pituitary insufficiency. In both patients, acetylcholine challenge clearly revealed both the presence and the severity of myocardial bridging while producing several recognizable degrees of abnormal spastic tendency.Both baseline functional states and responses to different medications correlate with spastic tendency and enable the characterization of individual cases. Understanding the spectrum of spastic conditions might help to clarify the causes of atypical ischemic events, especially in patients with myocardial bridging.
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Affiliation(s)
- Paolo Angelini
- Division of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
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Abstract
Cardiac remodelling is commonly defined as a physiological or pathological state that may occur after conditions such as myocardial infarction, pressure overload, idiopathic dilated cardiomyopathy or volume overload. When training excessively, the heart develops several myocardial adaptations causing a physiological state of cardiac remodelling. These morphological changes depend on the kind of training and are clinically characterised by modifications in cardiac size and shape due to increased load. Several studies have investigated morphological differences in the athlete's heart between athletes performing strength training and athletes performing endurance training. Endurance training is associated with an increased cardiac output and volume load on the left and right ventricles, causing the endurance-trained heart to generate a mild to moderate dilatation of the left ventricle combined with a mild to moderate increase in left ventricular wall thickness. Strength training is characterised by an elevation of both systolic and diastolic blood pressure. This pressure overload causes an increase in left ventricular wall thickness. This may or may not be accompanied by a slight raise in the left ventricular volume. However, the development of an endurancetrained heart and a strength-trained heart should not be considered an absolute concept. Both forms of training cause specific morphological changes in the heart, dependent on the type of sport. (Neth Heart J 2008;16:129-33.).
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Affiliation(s)
- C Mihl
- Department of Cardiology, Maastricht University Hospital, Maastricht, the Netherlands
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Abstract
A 60-year-old female patient with Prinzmetal angina and a single non-critical (<50%) focal obstruction in the right coronary artery was referred for percutaneous coronary intervention. Coronary angiography with provocative testing using incremental doses of acetylcholine demonstrated diffuse mild vasoconstriction and multifocal hyperreactive vasoconstriction in apparently normal coronary segments but not at the site of the nonsignificant obstruction. We refrained from intervention and advised avoidance of beta-blockade, and continuation of medical therapy with nitrates and calcium antagonists. (Neth Heart J 2008;16:134-6.).
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Affiliation(s)
- H.R. Michels
- Department of Cardiology Catharina Hospital, Eindhoven, the Netherlands
| | - H.F. Baars
- Department of Cardiology Twee Steden Hospital, Tilburg, the Netherlands
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