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Angina in thyrotoxicosis. Thyroid-related coronary artery spasm.

Ischemic heart disease is a common complication of thyrotoxicosis, although the exact mechanism has not been defined. A case is reported of angina and thyrotoxicosis in which the angina was reproduced by coronary artery spasm induced by ergonovine maleate, relieved by thyroid ablation, and reactivated by postablative thyroid replacement. Coronary arteriography did not show significant stenoses prior to ergonovine injection. Possible mechanisms of coronary artery spasm in thyrotoxicosis are briefly discussed. Hyperthyroidism should be considered as a cause of angina in any patient with rest pain and normal coronary arteries.

Angina Pectoris↗

Oculosympathetic spasm with cervical spinal cord injury.

A 23-year-old man, involved in a motor-vehicle accident, became quadraparetic due to cervical spinal cord injury at the C-4 to C-6 level. Five months later he was noted to have bilateral, asymmetric pupillary mydriasis precipitated by elevation and stretch of an arm or leg. Pharmacologic pupillary testing and ciliospinal reflex responses suggested that the oculosympathetic pathways were intact. Computed tomographic myelography using metrizamide disclosed a posttraumatic syringomyelic cyst at C-4. This pupillary phenomenon has been termed oculosympathetic spasm, and we reviewed four previous reports. While the cause of oculosympathetic spasm remains speculative, it may represent a localized form of autonomic hyperreflexia.

Accidents, Traffic↗

Internal capsule plaque and tonic spasms in multiple sclerosis.

A patient developed hemilateral tonic spasms associated with a relapse of multiple sclerosis. An area of demyelination in the right internal capsule was observed on a magnetic resonance imaging scan. This lesion was not detectable on a second magnetic resonance imaging scan 10 months after the spasms had ceased. Paroxysmal symptoms in multiple sclerosis may represent transient phenomena related to inflammation in acute plaques.

Adult↗

Laryngeal spasm complicating pseudomyotonia.

Pseudomyotonia is a syndrome characterized by progressive muscle stiffness, weakness, myokymia, hyperhydrosis, and wasting of muscle. It especially affects the distal aspect of the extremities. The electromyogram is characteristic, and shows continuous muscle activity at rest. We discuss a case that is believed to be the first recorded instance of pseudomyotonia complicated by airway obstruction secondary to laryngeal spasm. Treatment with phenytoin sodium resulted in rapid improvement of the peripheral symptoms and simultaneous resolution of the laryngeal spasm.

Adult↗

Comparative study of Nd:YAG laser angioplasty at 1.06 microns, 1.32 microns, and 1.44 microns wavelengths: decreased vascular spasm and early mortality with 1.44 microns laser ablation.

BACKGROUND AND OBJECTIVE: Although laser angioplasty has been demonstrated to be effective for the treatment of long, complex coronary arterial atherosclerotic stenoses, there is an associated risk of acute arterial spasm, dissection, and perforation as well as a significant restenosis rate. It has been postulated that the use of lasers emitting at wavelengths designed for radiation absorption by water would decrease local tissue trauma. STUDY DESIGN/MATERIALS AND METHODS: We have examined the use of a Nd:YAG laser designed to emit at 1.44 microns, an absorption peak for water, and compared the results of laser ablation at 1.06 microns, 1.32 microns, and 1.44 microns wavelengths. Nd:YAG laser angioplasty was performed in the abdominal aorta of White Leghorn roosters. Acute and chronic vascular trauma was assessed by contrast angiography and histological analysis. RESULTS: There was a significant decrease in early mortality with 1.44 microns laser ablation. This decreased mortality after 1.44 microns ablation was associated with a decrease in vascular spasm, perforation, and thermal damage. Atherosclerotic plaque development at follow up was decreased with 1.44 microns ablation but this was not significant. CONCLUSION: 1.44 microns laser ablation decreases early vascular trauma and mortality and may decrease subsequent atherosclerotic plaque development.

Angiography↗

Prolonged catheter-induced coronary artery spasm mimicking fixed stenosis.

Two cases of prolonged catheter-induced right coronary artery spasm, mimicking fixed stenoses, are presented. In one case, the spasm appeared at the same place in sequential catheterizations. This angiographic finding may be easily misinterpreted as a fixed lesion, leading to unnecessary attempts at angioplasty.

Adult↗

Hemifacial spasm and the facial nucleus.

Spontaneous and associated hyperkinetic facial movements and contracture which follow injury to the seventh cranial nerve (postparalytic hemifacial spasm) or arise without known previous injury (cryptogenic hemifacial spasm) are pathological motor phenomena not found in the distribution of other cranial or somatic motor nerves. The commonly expressed hypotheses of pathogenesis--aberrant regeneration and fiber excitation by false synapse formation (ephapses) at the site of injury--cannot account for all aspects of these phenomena or for the uniqueness of such movements to the distribution of the seventh nerve. The suggestion is made that the existing diversity of facial motor behavior, which encompasses voluntary, emotional, and especially automatic, associated, and reflexive movements, is based on a unique central organization that sets it apart from other motor groups. I hypothesize that because of this organization, the changes following axonal injury--which include selective deafferentation, glial response, axonal sprouting, functional reconnection, and hyperexcitability from dendritic spike generation--can unmask and augment automatic, associated, and reflexive movements already present in the facial neuronal network to result in facial hyperkinesia.

Animals↗

Coronary artery catheter-induced spasm.

A patient developed a lesion in the proximal and mid right coronary artery during cardiac catheterization. Following the administration of nitroglycerin, repeat right coronary angiography showed a normal right coronary artery. Therefore, distal lesions associated with catheter-induced spasm in the same coronary artery should not always be considered "fixed" lesions; but rather, they may be due to spasm.

Cardiac Catheterization↗

Laminar flow due to venous valves masquerading as vein graft spasm.

Two cases of laminar flow at the venous valves were found to produce a tapered appearance of the vein grafts, similar to spasm, during angiography. This possibility should be kept in mind when considering the diagnosis of spasm in a vein graft during postoperative angiographic studies. In addition, the follow-up of these cases suggests that valves may predispose to later stenosis or occlusion of the vein grafts.

Adult↗

Coronary artery spasm in a denervated orthotopic transplanted human heart.

A case of catheter-induced spasm in a 40-year-old male one year after orthotopic cardiac transplantation is presented. The fact that spasm can occur in this setting of total cardiac denervation demonstrates that other factors can play an important part in modifying the status of coronary artery patency.

Adult↗

Cigarette smoking during coronary angiography: diffuse or focal narrowing (spasm) of the coronary arteries in 13 patients with angina at rest and normal coronary angiograms.

To evaluate the acute effects of cigarette smoking on coronary arteries (CA), repeated coronary angiograms were performed in 13 patients with angina at rest and with normal coronary angiograms at basal state, during smoking, and then after methylergometrine (MEM) and after intracoronary nitroglycerin. Smoking induced anginal pain in three patients, triggered spasm (focal narrowing) in six, and/or an abnormal segmental diffuse narrowing (greater than 30%) in eight. The narrowing of the left CA was on average -21 +/- 13% (P less than 0.001), with more important narrowing of the mid-left anterior descending (-29 +/- 19%, P less than 0.001). The mean of the maximal segmental narrowing by patient was -34 +/- 13% (P less than 0.001). MEM produced similar effects and induced focal CA spasms in nearly the same patients at the same sites. Cigarette smoking may induce vasoconstrictive effects on CA in patients with rest angina and normal coronary angiograms. This action is not dose-dependent and may be initiated by less than one cigarette. These observations offer a new perspective for the understanding of the role of smoking in the precipitation of coronary events.

Adult↗

Coronary artery spasm culminating in thrombosis following ergonovine stimulation.

A 53-yr-old active man with angina but no angiographically significant obstructive coronary artery disease developed refractory spasm following ergonovine provocation. This resulted in thrombus formation and myocardial infarction. As such, this is the first case in which thrombosis developed at the site of intense coronary artery spasm induced by ergonovine, all of which were documented angiographically. Despite the notable safety of this test, this case re-emphasizes the potential of ergonovine to produce intractable myocardial ischemia and infarction.

Cardiac Catheterization↗

Sudden cardiac death from coronary artery spasm in a healthy subject.

The true incidence of sudden cardiac death (SCD) from coronary artery spasm is unknown. The following case involves SCD in a previously asymptomatic young man with reasonable evidence to implicate coronary artery spasm as a potential cause for his clinical event. Ergonovine provocation may be warranted in patients who present with SCD and no discernable cause.

Adult↗

Clinical characteristics and prognosis of patients with postinfarction angina caused by coronary artery spasm.

Clinical features and the course of 15 patients with postinfarction angina caused by coronary artery spasm are described. Episodes of postinfarction angina in the patients recurred at rest in the early recovery phase and were accompanied by transient ST-segment elevation. The area where ST-segment elevations were demonstrated on a 12-lead ECG always included the leads with newly developed abnormal Q waves. Pain resolved spontaneously or after sublingual nitroglycerin in several minutes. Holter ECGs during a 24-h period demonstrated frequent episodes of ST-segment elevation that were not always associated with chest pain. Treatment with calcium antagonist and/or nitrates effectively suppressed angina, and only one patient developed reinfarction. The patient's subjective symptoms were abolished by diltiazem and isosorbide dinitrate. A Holter ECG of the patient revealed silent ST-segment elevations before and after the reinfarction and an increase of the drugs completely suppressed the recurrence of silent ischemic ECG changes. Coronary arteriograms were obtained from 8 patients, which demonstrated more than 75% segmental stenosis on one coronary artery in 5 patients and no significant obstruction in the remaining 3. All patients performed a treadmill exercise stress test before discharge and most demonstrated excellent tolerance. All patients experienced no form of chest pain for an average of 25 months follow-up under medication. We conclude that among patients with postinfarction angina, those cases caused by coronary artery spasm have a relatively good prognosis.

Adult↗

Left ventriculography induced coronary artery spasm.

Angiographic contrast material is generally considered a vasodilator, although in vitro experiments have documented a spasmogenic effect. In this report we describe a patient with exercise and rest angina who developed spasm of the right coronary artery immediately following left ventricular angiography. The patient was treated successfully with calcium channel blockers. This is the first reported case of left ventricular angiography-induced coronary artery spasm.

Angiocardiography↗