Spasm of a normal or minimally narrowed coronary artery in the presence of severe fixed stenoses of the remaining vessels: clinical and angiographic observations.

Abstract

PATIENTS with stable angina occasionally experience symptomatic exacerbation. Their anginal pain occurs more frequently and can also appear at rest. This may represent worsening coronary artery disease, and if the angina is unresponsive to medical therapy, coronary angiography is considered. If severe, operable lesions are found, coronary bypass surgery is then considered,We present four patients in whom this sequence occurred. However, most of their symptoms were apparently due to spasm of a normal or minimally diseased coronary artery. In our laboratory, coronary artery spasm was induced with ergonovine maleate using the following protocol: 0.05-mg doses are administered intravenously at 3-minute intervals until either chest pain or electrocardiographic abnormalities are noted or a total dose of 0.2 mg is given. Failure to identify the etiologic role of the coronary spasm would have led to inappropriate clinical decisions.

Coronary Artery Spasm-Related Acute Coronary Syndrome in Patients With Coexisting Spasm of Angiographically Normal Coronary Artery and Fixed Narrowing of the Remaining Vessels

“…The results reported here support prior observation 5,6 that fixed narrowing of the coronary artery does not always produce myocardial ischemia. Prinzmetal et al 7 first described the syndrome of variant angina and they suggested that the transient ST-segment elevation is due to temporary total occlusion of a diseased coronary artery.…”

“…Mautner 5 reported that seven patients with significant fixed occlusive coronary artery disease had coronary artery spasm in a "normal" vessel, of which six had spontaneous spasm during catheterization and one ergonovine-induced spasm. Mercurio et al 6 reported four patients with medically refractory rest angina. During cardiac catheterization, intravenous ergonovine reproduced the chest pain and induced coronary artery spasm in a normal or minimally diseased vessel, despite the presence of fixed stenosis in the remaining vessels.…”

“…[1][2][3][4] Both coronary artery spasm with no fixed obstruction and coronary artery atherosclerosis with fixed obstruction can cause acute coronary artery occlusion, with resultant myocardial ischemia and infarction. 5,6 It is important to identify the predominant factor causing the patient's symptoms, as the choice of treatment will vary. In this report, we present our experience with patients presenting with acute coronary syndrome and found to have both fixed obstruction and coronary artery spasm.…”

Myocardial ischemia in patients with fixed occlusive coronary artery disease secondary to vasospasm in the “normal” vessel

“…Six patients had one or more episodes of rest angina and four sustained recent myocardial infarction. Mercurio et a1 reported four patients with medically refractory rest angina [2]. During cardiac catheterization intravenous ergonovine maleate reproduced the chest pain and induced coronary vasospasm in a normal or minimally diseased vessel, despite the presence of fixed stenosis in the remaining vessels.…”

Morphological features of coronary arteries in patients with coronary spastic angina: Assessment with intracoronary optical coherence tomography

“…Previous studies have indicated that endothelial dysfunction of coronary arteries plays a pivotal role in the development of CS [5,6], and CS occurs in both patients with normal coronary angiograms and also in those with atherosclerotic coronary stenosis [7][8][9]. For the differential diagnosis of CS, provocation tests using acetylcholine (ACh) or ergonovine are usually performed, and intracoronary injection of ACh is reported to be sensitive (N90%) and reliable for the diagnosis of CS [10,11].…”