Vasospastic Angina in Identical Twins

Abstract

Patient: Male, 58Final Diagnosis: Vasospastic anginaSymptoms: Chest painMedication: —Clinical Procedure: Medical treatmentSpecialty: CardiologyObjective:Rare diseaseBackground:The clinical conditions of various diseases, including coronary artery disease, are determined by genetics and the environment. Previous investigations noted the significance of genetic mutations and polymorphisms in cases of coronary spasm.Case Report:We report on monozygotic identical twins who almost simultaneously presented with vasospastic angina. The 58-year-old younger twin was admitted to our hospital because of persistent chest pain. An electrocardiogram showed an inverted T wave in the left precordial leads. Coronary angiographies revealed a short left main trunk (LMT) and 50% stenosis at the proximal portion of the left anterior descending artery (LAD). Infusion of acetylcholine to his left coronary artery caused marked vasoconstriction associated with a sensation of chest oppression. Nitroglycerine completely reversed this response. Based on these findings, we diagnosed Twin A with vasospastic angina. At nearly the same time, his identical twin brother was diagnosed with vasospastic angina at another hospital. Comparison of both coronary angiograms indicated similar structure of coronary vessels, including short LMT and mild stenosis at the proximal portion of LAD.Conclusions:These 2 cases highlight the importance of genetic factors in the pathogenesis of vasospastic angina. It may be important for individuals to receive medical attention if their identical twin presents with vasospastic angina.

Familial risk of vasospastic angina: a nationwide family study in Sweden

“…Despite the identified genetic associations, 11 14–17 the environmental factor smoking remains the most significant adverse trigger for VSA, impacting several disease pathways related to these genetic variants and leading to substantial gene–environment interactions. 18 Although smoking and nicotine are generally perceived as harmful, especially for those with strong genetic predispositions, they may sometimes yield paradoxical effects in certain individuals. 19 This complexity suggests the existence of unknown patient-specific factors that could influence individual vasoactive response to these triggers.…”