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At least 721 records · Page 40Linked to original sources
PubMed1987

Human leucocyte antigen in variant angina.

Human leucocyte antigen analysis of 45 patients with variant angina was performed to determine the presence of causative genetic factor(s). A significantly low frequency of human leucocyte antigen DQ omega 3 was found in these patients, as compared with that in 152 normal Japanese adults. There were no differences in frequencies of antigens between patients with normal and those with atherosclerotic coronaries. These data suggest that some genetic factor(s) may contribute to the pathogenesis of coronary spasm.

Angina Pectoris, Variant↗
PubMed1998

Collateral flow detected by a Doppler guide wire in a case of vasospastic angina.

We could detect recruitable backward collateral flow in systole and diastole by using a Doppler guide wire during coronary artery spasm in a 42-year-old female among 20 patients with documented variant angina. The electrocardiogram (ECG) showed no ST-segment deviation, although she had chest pain and her coronary angiography showed a totally occluded right coronary artery. After administration of isosorbide dinitrate (ISDN) the collateral flow disappeared and the flow pattern recovered to normal. The good collateral flow pattern in patient with totally occluded coronary artery due to spasm was indicated to relieve myocardial ischemia, even when the patient felt chest pain.

Adult↗
PubMed1978

Prinzmetal's angina, normal coronary arteries and pericarditis.

A woman with Prinzmetal's variant angina had spontaneous attacks of myocardial ischemia characterized by severe chest pain, hypotension, inferior ST-segment elevation, transient complete heart block and selective right ventricular dysfunction. Despite initial improvement following intravenous administration of atropine and sublingual administration of nitroglycerin she died of cardiogenic shock. Autopsy showed normal coronary arteries and acute pericarditis, more pronounced over the right side of the heart. It is postulated that the pericardial inflammation elicited severe spasm of the subjacent right coronary artery.

Aged↗
PubMed1990

Variant angina due to deficiency of intracellular magnesium.

A 51-year-old man was diagnosed as having variant angina by documentation of typical ST elevation during anginal attack and also by showing coronary arterial spasm (#2 and #12) during hyperventilation on coronary arteriography. Large quantities of calcium blocking agents and nitrates could not improve his symptoms. Lack of intracellular magnesium was suspected from a daily excretion of urine magnesium (5.3 mEq) and magnesium tolerance test (56.7%). After hourly infusion of magnesium sulfate (80 mEq), coronary spasm could not be induced by ergonovine.

Angina Pectoris, Variant↗
PubMed1977

Provocative testing for coronary arterial spasm: rationale, risk and clinical illustrations.

Two cases of Prinzmetal's variant angina are presented in which coronary spasm was documented by electrocardiographic evidence obtained in the coronary care unit during provocative testing with ergonovine maleate after the arteriographic demonstration of anatomically normal coronary arteries. The rationale and risks of provocative testing for spasm in patients with chest pain and anatomically normal coronary arteries are reviewed. The advantages of performing provocative testing in the coronary care unit after arteriography rather than in the catheterization laboratory during coronary arteriography are discussed.

Adult↗
PubMed1982

[Meningeal hemorrhage disclosed by the initiation of Prinzmetal's angina].

The association of a cardiac disturbance and a subarachnoïd hemorrhage is well known but the cardiac signs seldom look the most important. When studying a case which was very particular because the cardiac signs consisted in a Prinzmetal's variant angina, it finality appears that the Prinzmetal's angina is not so rare as could be thought in such circumstances. Therefore a neurological pathology hidden by a cardiac one has been rarely reported such as it was seen in that case. In the literature, the influence of the parasympathetic and especially the sympathetic nervous system is emphasized as a probable cause of the most frequent cardiac abnormalities. All the authors think the medical cardiac treatment and the surgical treatment of the subarachnoïd hemorrhage have to be done at once.

Angina Pectoris, Variant↗
PubMed1985

Prinzmetal's variant angina evolved in inferior myocardial infarction with involvement of the right ventricle: sequential radionuclide evaluation.

A patient with Prinzmetal's variant angina (PVA) who developed an inferolateral myocardial infarction with right-ventricle involvement was studied using sequential radionuclide imaging until 5 months after the acute event. The patient also underwent-contrast ventriculography and coronary-artery angiography. Equilibrium-gated radionuclide angiography (EGRA) revealed the localization of ventricular dysfunction, the results obtained being in agreement with haemodynamic data. We emphasize the usefulness of the parameters obtained using EGRA (regional wall motion, systolic and diastolic parameters) in planning therapy and follow-up.

Angina Pectoris, Variant↗
PubMed1985

The diagnosis of coronary artery spasm in the cardiac catheterization laboratory.

Coronary artery spasm can now be well documented in the cardiac catheterization laboratory. At present, reliable criteria are available for the diagnosis of severe episodes that are characteristic of patients with Prinzmetal's variant angina. Newer criteria for the diagnosis of milder episodes of spasm are gradually being developed. Optimal criteria may become available with further progress of quantitative angiography. Provocation techniques for the induction of an attack of spasm in the cardiac catheterization laboratory are widely available. Of these, ergonovine testing is the most popular. The tests can usually be performed by experienced angiographers with impressive safety and provide a high degree of sensitivity and specificity when used in patients with the clinical diagnosis of variant angina. Although the research applications of such techniques are extremely broad, their practical clinical indications are somewhat limited to the work-up of patients with infrequent chest pains and normal or near-normal coronary arteriograms. There are other indirect methods for the diagnosis of coronary spasm, but the ideal technique is not available yet. Further expansion of newer modalities for the diagnosis of coronary artery spasm will certainly enhance our understanding of myocardial ischemia and will improve our ability to manage patients with ischemic heart disease.

Angina Pectoris, Variant↗
PubMed1984

Myocardial ischemia during ergonovine testing: different susceptibility to coronary vasoconstriction in patients with exertional and variant angina.

Coronary spasm is an accepted cause of transient myocardial ischemia in patients with variant angina; more recently it has been suggested that dynamic stenoses could also play an important role in the pathophysiology of exertional angina. To test this hypothesis we submitted 31 patients with histories typical of exertional angina to ergonovine testing and compared the electrocardiographic and clinical responses to those observed in seven patients with variant angina. All underwent bicycle ergometric exercise testing and coronary angiographic examination. For all tests, ST segment shifts of 0.1 mV or greater were considered to be diagnostic of myocardial ischemia. In patients with exertional angina, exercise testing produced diagnostic ST segment depression in 21 (68%). Ergonovine testing produced diagnostic ST segment depression in nine (29%). All nine had positive exercise test results and two- or three-vessel disease, yet the test was negative in seven other patients with positive exercise test results and similar angiographic findings. Conversely, in the seven patients with variant angina, results of exercise testing were positive in five (ST segment depression in two, ST elevation in three), while ergonovine produced ST segment elevation in all seven. Coronary angiographic examination showed normal arteries in two, one-vessel disease in four, and three-vessel disease in one. Results of all ergonovine tests were positive at values of rate pressure product much lower than those observed during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Nifedipine therapy for coronary vasospasm.

In conclusion, we observed first that nifedipine is highly efficacious in preventing the coronary vasospasm of Prinzmetal's variant angina. Secondly, nifedipine appears to be efficacious in preventing episodes of recurrent rest angina following an acute myocardial infarction. Although coronary vasospasm has not been clearly documented in patients with recurrent rest angina after infarction, a primary decrease in coronary blood flow is the most likely cause of this syndrome since the ischemia occurs at rest, at a time when myocardial oxygen demands are not elevated. In this highly unstable group of patients with coronary disease nifedipine may eliminate the need for bypass surgery or may provide clinical stability prior to more elective cardiac catheterization and surgery.

Angina Pectoris↗
PubMed1978

ST-segment elevation during recovery from exercise. A new manifestation of Prinzmetal's variant angina.

Four patients underwent exercise testing because of a history of pain in the chest; all four developed marked elevation of the S-T segment only during recovery after exercise. Three of the four patients showed ST-segment depression during exercise, but ST-segment elevation was absent until two or more minutes after cessation of exercise. ST-segment elevation after exercise was accompanied by hypotension in three patients and by ventricular arrhythmias in one. Subsequent coronary angiographic studies revealed normal or minimally diseased coronary arteries in two patients and significant coronary lesions in the other two. Review of the literature shows that contrary to the prevailing belief, over half of the patients with Prinzmetal's variant angina have electrocardiographic changes diagnostic of ischemia during exercise testing. Over half of the patients with abnormal findings on tests during exercise display ST-segment elevation as a manifestation of ischemia; however, delayed ST-segment elevation of the type seen in these four patients is distinctly uncommon, having previously been described in only three individual case reports. The pathophysiology of this response is uncertain but may relate to rapid alterations in the autonomic balance during recovery after exercise.

Adult↗
PubMed1985

Occlusion and reperfusion as possible different mechanisms of ventricular tachyarrhythmias in Prinzmetal's variant angina.

A case of a patient with variant angina associated with severe ventricular tachyarrhythmias studied by continuous electrocardiographic and haemodynamic monitoring is reported. Severe ventricular arrhythmias developed both during maximal ST-segment elevation, in association with haemodynamic signs of acute ischaemic cardiac dysfunction and after nitroglycerin-induced reversion of ischaemia and return of the haemodynamic variables to the basal state. Thus, in this patient, ventricular arrhythmias during acute ischaemia could be related not only to acute vasospastic coronary occlusion but probably also to reperfusion after relief of coronary spasm.

Angina Pectoris, Variant↗
PubMed1999

Racial heterogeneity in coronary artery vasomotor reactivity: differences between Japanese and Caucasian patients.

Japanese investigators have provided a substantial contribution in the understanding of coronary vasomotor reactivity. On occasions, their findings have been at variance with those undertaken on caucasian patients, raising speculation that vasomotor differences between races may exist. In a comparative review of the published literature, we evaluated the vasoreactive differences among Japanese and caucasian patients with variant angina or myocardial infarction. In variant angina, Japanese patients appear to have diffusely hyperreactive coronary arteries compared with caucasian people, manifested by their segmental rather than focal spasm, hyperreactive nonspastic vessels and multivessel spasm. These differences may reflect the increased basal tone among Japanese variant angina patients and may relate to controversial differences in endothelial nitric oxide production or autonomic nervous system activity. Provocative vasomotor studies of Japanese patients with a recent myocardial infarction report a higher incidence of inducible spasm than caucasian studies, an observation recently supported by a controlled study. Furthermore, the hyperreactivity was diffuse, occurring in both non-infarct- and infarct-related vessels. These observations support the existence of racial coronary vasomotor reactivity differences but require confirmation in further prospectively conducted studies.

Adult↗
PubMed1983

Electrocardiographic recognition of variant angina during permanent pacing.

We present a patient with a permanent ventricular pacemaker who was investigated for episodes of chest pain associated with syncope. Ambulatory electrocardiographic monitoring showed essentially paced rhythm. ST segment elevation of the paced beats was observed during spontaneous chest pain, but the significance of this finding was initially unclear in the context of the abnormal repolarization associated intrinsically with paced rhythm. At angiography, coronary spasm was demonstrated after ergonovine, and this was associated with ST segment elevation during paced rhythm and with chest pain. We conclude that ST segment elevation may indicate myocardial ischemia even when observed in the face of abnormal repolarization associated with paced rhythm.

Angina Pectoris, Variant↗
PubMedDate not supplied

Surgical treatment of variant angina with positive cold pressor test.

Coronary artery spasm is provoked by exercise, cold pressor test and pharmacological agents during cardiac catheterization. We describe a patient in whom the coronary artery was excessively sensitive to cold pressor test, and who was treated by coronary artery bypass grafting (CABG) combined with cardiac denervation. Postoperative coronary arteriogram showed decreased sensitivity to cold pressor test with patent graft. These observations suggest that combined CABG with cardiac denervation is indicated for patients with fixed organic coronary artery narrowing and positive provocative test, and that postoperative cold pressor test during coronary arteriography is a useful, low risk method for the evaluation of the efficacy of cardiac plexectomy.

Adult↗
PubMed1976

[Prinzmental's angina and disturbances of the stimulus conduction (author's transl)].

Our series (30 cases) of variant angina as well as the reports from literature, were reviewed, to investigate the consequences of an acute regional ischemia on seno-atrial, atrio-ventricular and intraventricular conduction. Sinoatrial conduction was never affected independently from the anterior or posterior localization of the ischemia. A junctional impairment of atrio-ventricular conduction was rather frequent in cases of variant angina affecting the inferior wall, ranging in different series from 8% to 25%. Only one case of bundle branch block was observed. Hemiblocks were found to be extremely rare, while a deviation of the main axis of the QRS on the frontal plane, especially to the left in cases with anterior localization of the ischemia, was observed quite frequently. This axis deviation, in the absence of changes of the initial vector of the QRS compatible with the diagnosis of hemiblocks, were considered to be depending on a parietal block.

Angina Pectoris↗
PubMed1985

[Clinical significance of early redistribution of the exercise-induced thallium-201 defect in ischemic heart disease].

This study clarified thallium-201 (Tl) kinetics in the early stage after exercise in patients with ischemic heart disease (IHD). Tl was administered for 39 patients with IHD and eight normal subjects during maximal exercise. Immediately after exercise, dynamic data were obtained using a double slant-hole collimator at one frame/2 min for a 20 min period. The data of 10 frames (20 min) were spatially smoothed, and semiquantitative segmental analyses of the uptake and kinetics of Tl were performed by computer. In eight normal subjects, Tl uptake was uniform throughout the continuous 20 min, and Tl activity was unchanged throughout the 20 min period after exercise. Among 39 patients with IHD, 39 had Tl defects in the first frame (initial defect). Among 39 initial defects, 15 (38%) showed complete or partial early redistribution as early as 20 min and Tl activity in the defect increased (10.5 +/- 1.5%) over the 20 min period. Early redistribution occurred in 10 (43%) of 23 patients with effort angina and in five (83%) of six patients with variant forms of angina, but in no patients with myocardial infarction. Patients with early redistribution showed a greater frequency either of good collateral vessels or of mild stenosis of the coronary artery, compared with those who had no early redistribution. In conclusion, analysis of Tl kinetics in the early stages after exercise can provide important information about the coronary perfusion state during recovery from transient ischemia, and early redistribution may be a sign of preserved hyperemic flow in the ischemic region.

Angina Pectoris↗
PubMed2006

[Syncope as a first manifestation of Prinzmetal's angina in a 49-year-old woman. A case report].

A case of a 49-year-old woman with episodes of syncopes as a first manifestation of variant angina is presented. She was admitted to cardiology ward because of recurrent angina associated with marked ST segment elevation in the inferior and anterior electrocardiographic leads. Previously she was diagnosed at a neurological ward because of nocturnal syncopes without accompanying chest pain but with associated hypotonia and bradycardia of about 36 beats/min. Coronary arteriography revealed non-significant coronary stenosis of two vessels (left and right coronary artery) and coronary spasm close to these obstructions. Therapy with calcium channel blockers as well as giving up smoking eliminated the episodes of chest pain and syncope in a twelve-month follow-up.

Angina Pectoris, Variant↗