Coronary Computed Tomography Angiography for the Diagnosis of Vasospastic Angina: Comparison with Invasive Coronary Angiography and Ergonovine Provocation Test

OBJECTIVE: To investigate the diagnostic validity of coronary computed tomography angiography (cCTA) in vasospastic angina (VA) and factors associated with discrepant results between invasive coronary angiography with the ergonovine provocation test (iCAG-EPT) and cCTA. MATERIALS AND METHODS: Of the 1397 patients diagnosed with VA from 2006 to 2016, 33 patients (75 lesions) with available cCTA data from within 6 months before iCAG-EPT were included. The severity of spasm (% diameter stenosis [%DS]) on iCAG-EPT and cCTA was assessed, and the difference in %DS (Δ%DS) was calculated. Δ%DS was compared after classifying the lesions according to pre-cCTA-administered sublingual nitroglycerin (SL-NG) or beta-blockers. The lesions were further categorized with %DS ≥ 50% on iCAG-EPT or cCTA defined as a significant spasm, and the diagnostic performance of cCTA on identifying significant spasm relative to iCAG-EPT was assessed. RESULTS: Compared to lesions without SL-NG treatment, those with SL-NG treatment showed a higher Δ%DS (39.2% vs. 22.1%, p = 0.002). However, there was no difference in Δ%DS with or without beta-blocker treatment (35.1% vs. 32.6%, p = 0.643). The significant difference in Δ%DS associated with SL-NG was more prominent in patients who were aged < 60 years, were male, had body mass index < 25 kg/m2, and had no history of hypertension, diabetes, or dyslipidemia. Based on iCAG-EPT as the reference, the per-lesion-based sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of cCTA for VA diagnosis were 7.5%, 94.0%, 60.0%, 47.1%, and 48.0%, respectively. CONCLUSION: For patients with clinically suspected VA, confirmation with iCAG-EPT needs to be considered without completely excluding the diagnosis of VA simply based on cCTA results, although further prospective studies are required for confirmation.

Successful Treatment of Coronary Spasm with Atherosclerosis Rapidly Progressing to Acute Myocardial Infarction in a Young Woman

Variant angina pectoris (VAP) is a special type of unstable angina with coronary artery spasm as the main pathogenesis, characterized by resting chest pain, and transient ST segment dynamic changes. The development of acute myocardial infarction is not uncommon. We report a case of a 49-year-old female patient diagnosed with VAP at 2 years before who suddenly suffered severe chest pain. Troponin-I was elevated. Immediate coronary angiography showed near-total occlusion in the proximal left anterior descending artery, which was not fully dilated despite use of intracoronary nitroglycerin. Intravascular ultrasound showed focal significant stenosis with a large amount of plaque at the site of spasm and the lesion was successfully treated with drug-eluting stent placement. Intravascular imaging may be instrumental in high-risk patients with VAP who suffer recurrent chest pain despite intensive anti-spasm medications.

Clinical studies of Sangi Tonglero decoction on dynamic electrocardiogram in patients with variant angina pectoris / 中国生化药物杂志

Objective To investigate the effect of Sangi Tonglero decoction on dynamic electrocardiogram and clinical results, in order to improve the level of clinical treatment. Method 110 Patients with variant angina pectoris in February 2010 to February 2013 were selected and divided randomly into two groups. 55 patients in control group were given amlodipine treatment , the other in observation group were added Sangi Tonglero decoction beside amlodipine treatment. The differences in electrocardiogram and clinical effects between two groups after treatment were compared. Results The clinical results of dynamic electrocardiogram and angina were showed that the efficiency rate and total efficiency rate in observation group were significantly higher than that in control group(P<0.05). The difference of lipid levels, blood rheology indicators between two groups after treatment were statistically significant (P<0.05). Conclusion Dynamic electrocardiogram is a preferred method of checking variant angina pectoris , and Sangi Tonglero decoction can significantly improve the therapeutic effect .

Coronary Spastic Angina and Life Threatening Arrhythmia despite Nitroglycerine Infusion / 이화의대지

Variant angina pectoris is characterized by chest symptoms at rest and transient ST elevation on the electrocardiography due to coronary artery spasm. Although most patients with coronary spasm respond well to medical treatment with vasodilators such as calcium channel blockers and nitrates, some patients show intractable attack of coronary vasospasm despite standard medical therapy. We experienced 50-year-old woman with intractable chest pain due to coronary artery spasm, who suffered from ventricular fibrillation despite continuous intravenous nitrate therapy.

Ventricular Tachycardia due to Submucosal Epinephrine Injection during Septoplasty / 대한이비인후과학회지

Local infiltration of dilute solutions of epinephrine is widely used for the purpose of hemostasis during septal surgery. However, infiltrated epinephrine often make several side effects such as palpitation, hypertension, or arrhythmia. Also, it may be possible to experience the catastrophic events such as intracranial hemorrhage, pulmonary edema, and cardiac arrest when we use overdose of epinephrine. We experienced ventricular tachycardia in a 36-year-old male with no significant medical history, after submucosal infiltration of epinephrine with appropriate dose during septoplasty. Intraoperative cardiopulmonary resuscitation by external chest compression and direct current cardioversion was successful. We thoroughly evaluated the patient and proved the diagnosis of variant angina pectoris using coronary angiography.

Cardiovascular Risk Factors Predicting Endothelial Dysfunction in Patients with Variant Angina / 성인간호학회지

PURPOSE: This study was conducted to identify the clinical characteristics and risk factors on the occurrence of variant angina, and to examine the predicting factors on the vascular endothelial dysfunction of the patients with variant angina. METHODS: A total of 134 patients diagnosed with variant angina were recruited from 2006 to 2008. The degrees of endothelial dysfunction were measured and recorded by the researcher using the values of flow-mediated vasodilation of their brachial arteries and Nitroglycerine-mediated dilation. Subjects' demographic data and risk factors were gathered after obtaining informed consent, and their electronic medical records were reviewed to collect laboratory data. RESULTS: The mean age was 54.2 +/- 9.6 years and 52% was male patients. More than 50% of the male patients were cigarette smokers and had hypercholesterolemia. 84% of the male patients and 70% of the female patients had more than one risk factor of cardiovascular disease. A stepwise multiple regression analysis showed that smoking and hypercholesterolemia predicted the decrease of flow-mediated vasodilation (Adjusted R(2) = .204, p < .001). CONCLUSION: Tailored educational interventions for smoking cessation and cholesterol management are needed to prevent recurrence of angina attack for patients with variant angina and to prevent cardiovascular disease for middle-aged workers.