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PubMed1997

[Recurrent syncope without angina: an uncommon presentation of coronary spasm].

We report the case of a 64-year-old patient admitted for repetitive syncope as an isolated clinical manifestation probably due to coronary artery spasm. The patient had no history of previous cardiac disease, and was studied because of two nonspecific syncopes. Long-term electrocardiographic monitoring showed many episodes of transient ST segment elevation, associated with premature ventricular beats and runs of ventricular tachycardia. Coronary angiography during ergonovine infusion was performed to confirm the diagnosis. We discuss the incidence of coronary spasm provoking syncope and the need to establish a correct diagnosis in order to administer an effective therapy to the patient.

Angina Pectoris, Variant↗
PubMed2003

Rho-kinase inhibition with intracoronary fasudil prevents myocardial ischemia in patients with coronary microvascular spasm.

OBJECTIVES: We sought to determine whether a potent Rho-kinase inhibitor fasudil prevents the occurrence of myocardial ischemia in patients with microvascular angina attributable to coronary microvascular spasm. BACKGROUND: Effective treatment of patients with angina who have normal coronary arteriograms (microvascular angina) has not yet been established. Rho-kinase-mediated calcium sensitization of the myosin light chain in smooth muscle cells has been implicated as substantially contributing to vascular hyperconstriction. METHODS: We studied consecutive 18 patients with angina and normal epicardial coronaries in whom intracoronary acetylcholine (ACh) induced myocardial ischemia (ischemic electrocardiographic changes, myocardial lactate production, or both) without angiographically demonstrable epicardial coronary vasospasm. All patients underwent a second ACh challenge test after pretreatment with either saline (n = 5) or fasudil (4.5 mg intracoronarily, n = 13). RESULTS: Myocardial ischemia was reproducibly induced by ACh in the saline group. In contrast, 11 of the 13 patients pretreated with fasudil had no evidence of myocardial ischemia during the second infusion of ACh (p < 0.01). The lactate extraction ratio (median value [interquartile range]) during ACh infusion was improved by fasudil pretreatment, from -0.16 (-0.25 to 0.04) to 0.09 (0.05 to 0.18) (p = 0.0125). CONCLUSIONS: Fasudil ameliorated myocardial ischemia in patients who were most likely having coronary microvascular spasm. The inhibition of Rho-kinase may be a novel therapeutic strategy for this group of patients with microvascular angina.

1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗
PubMed1983

Natural history of pure coronary artery spasm in patients treated medically.

The clinical course of 59 patients with coronary artery spasm and no fixed severe coronary obstruction was analyzed for an average of 5.9 years. The study group consisted of 27 men and 32 women. Angina at rest was the predominant symptom in 93% of the patients. Myocardial infarction occurred in 19% and syncope during angina in 27%. During spontaneous anginal episodes, 64% of the patients showed ST segment elevation, 17% ST segment depression and 15% no electrocardiographic changes. Major arrhythmias during angina occurred in 24% of the patients. Permanent pacemakers were required in 10% of the patients. Stress tests were positive in 32% of the patients. Long-acting nitrate therapy controlled symptoms in only 31%, and calcium antagonist agents controlled symptoms in 83% of the patients unresponsive to nitrates. Spontaneous remission of angina for at least 1 month while receiving no medical treatment occurred in 39% of the patients. Fifteen percent of patients had an indefinite remission with no recurrence of symptoms for at least 2 years. There were no cardiac deaths. The natural history of medically treated patients with pure coronary spasm is characterized by recurrent angina at rest, frequent spontaneous remission, a poor response to long-acting nitrate therapy and a good response to calcium antagonists. Although myocardial infarction and major arrhythmias are common, cardiac mortality is low in medically treated patients.

Adult↗
PubMed1984

Refractory coronary artery spasm.

A patient with an episode of refractory myocardial ischemia induced by ergonovine is described. The patient underwent cardiac catheterization 2 weeks after an inferior wall myocardial infarction for evaluation of recurrent rest angina. He developed severe spasm of the proximal right coronary artery in response to ergonovine which was partially relieved with nitrates and calcium channel antagonists. However, myocardial ischemia persisted, culminating in a new inferior wall infarction. The possible mechanism of continuing intense ischemia despite partial relief of the proximal right coronary spasm is discussed. It is suggested that ergonovine testing should perhaps be avoided during the early postinfarction period. Furthermore, if an ergonovine test is anticipated, beta-adrenergic blocking agents should be withheld.

Aged↗
PubMed1987

Comparison of diltiazem and nifedipine alone and in combination in patients with coronary artery spasm.

Fifteen patients with coronary artery spasm completed a double-blind placebo-controlled trial comparing diltiazem and nifedipine. Increasingly, higher daily doses (diltiazem, 90 to 360 mg; nifedipine, 30 to 120 mg) were administered to achieve optimal clinical effects. Daily diaries and ambulatory electrocardiographic recordings were used to assess efficacy and side effects. Both drugs significantly decreased angina frequency compared with that in the preceding placebo period (diltiazem 1.4 +/- 0.4 [mean +/- SEM] to 0.4 +/- 0.2 episodes per day; nifedipine 1.4 +/- 0.3 to 0.4 +/- 0.1 episodes per day; both p less than 0.05). Ambulatory electrocardiographic recordings showed fewer ST shifts than were expected during all treatment periods (0.02/h recorded during placebo, none during diltiazem and 0.02/h during nifedipine therapy). Although some patients responded better to one drug than the other, neither drug resulted in a clearly superior clinical response. Diltiazem was discontinued in one patient because of urticaria, but the total number of side effects was higher with nifedipine (12 of 15 patients) than with diltiazem (5 of 15, p less than 0.01). Nine patients remained symptomatic on single drug treatment and entered open label treatment with the combination of diltiazem and nifedipine. Three patients did not tolerate the combination because of important side effects; the other six also had side effects, but these were relatively minor. Four patients received no more benefit from the combination than from a single agent; the condition of two patients improved. Both diltiazem and nifedipine provide effective antianginal therapy for coronary spasm, but diltiazem has fewer side effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Correction by a calcium inhibitor of a coronary spasm occurring during aortocoronary bypass].

A case of recurrent coronary artery spasm after coronary revascularization under cardiopulmonary bypass is related. The spasm, which occurred under nitroglycerin perfusion, was suspected on the ECG tracing and confirmed during immediate reoperation. It was successfully treated with bepridil, a calcium-channel blocking agent. The use of such agents after cardiac surgery is discussed.

Bepridil↗
PubMedDate not supplied

Values of intravenous ergonovine test with two-dimensional echocardiography for diagnosis of coronary artery spasm.

The purpose of this study was to evaluate the clinical validity of the bedside ergonovine test with digital echocardiography and the side-by-side continuous cineloop display method (ergonovine echocardiography) as a noninvasive diagnostic tool for coronary artery spasm. Bedside ergonovine test was performed in 66 patients who showed coronary vasospasm during coronary angiography including provocation testing (group with variant angina) and 39 patients with normal angiograms and no evidence of coronary artery spasm (group with nonanginal pain). A bolus of ergonovine maleate (0.025 or 0.05 mg) was injected at 5-minute intervals up to total cumulative dosage of 0.35 mg, and 12-lead electrocardiography and two-dimensional echocardiography were recorded every 3 minutes after each injection. Left ventricular wall motion was analyzed with a commercially available quad system. The positive criteria of bedside ergonovine test included reversible ST segment elevation or depression on electrocardiograms (ECG criteria) and reversible regional wall motion abnormalities by echocardiography (Echo criteria). The overall sensitivity and specificity of ECG criteria were 53% (35/66; 95% confidence interval 41% to 65%) and 100%, respectively. By Echo criteria the sensitivity increased to 89% (59/66; 95% confidence interval 81% to 97%), with a specificity of 95% (37/39).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris, Variant↗
PubMedDate not supplied

Severe acute coronary spasm following intracoronary radiation for in-stent restenosis: a case report.

Intracoronary radiation therapy is currently the only available treatment for the prevention of recurrence of in-stent restenosis. We report a case of severe coronary spasm after excimer laser angioplasty, balloon angioplasty, and intracoronary gamma radiation in the right coronary artery (RCA) that resulted in an acute myocardial infarction. Treatment with 600 microg of intracoronary nitroglycerin resulted in minimal improvement; therefore, diltiazem 400 microg was administered intracoronary with total resolution of the spasm, restoring normal coronary blood flow without trace of acute dissection or thrombus inside the artery.

Coronary Restenosis↗
PubMed2005

Pallister-Killian syndrome: an unusual cause of epileptic spasms.

Pallister-Killian syndrome (PKS) is a rare, sporadic, genetic disorder characterized by dysmorphic features, learning disability, and epilepsy. It is caused by a mosaic supernumerary isochromosome 12p (i[12p]). The i(12p) is rarely found in peripheral blood but it is present in skin fibroblasts. Recognition is essential for cytogenetic diagnosis. We describe a male aged 2 years 6 months and a female aged 11 years with PKS and epileptic spasms (ES). This type of seizure is not unusual in patients with brain malformations and with severe developmental delay, but it is sometimes difficult to recognize without video-electroencephalogram studies and could be mistaken for other types of seizure or behavioural manifestations. In these two patients with PKS, spasms had late onset, persisted beyond infancy, and were drug resistant. Clinicians should be aware of this possibility in PKS, which appears to be a rare cause of ES.

Child↗
PubMed1995

Latent tarsal tunnel syndrome with the provocation of flexor spasms in a paraplegic person. Case report.

A 71-year-old paraplegic woman presented with a complaint of insomnia caused by severe flexor spasms of the lower limbs at night, aggravated for a few hours by taking hot baths. Lidocaine injection of the tarsal tunnel diminished the flexor-withdrawal reflex, which was easily elicited by light pinching or sustained compression over the tarsal tunnel, and strongly suggested the existence of the tarsal tunnel syndrome. Surgical decompression of the tarsal tunnel significantly reduced the flexor spasms both in terms of frequency and of duration.

Aged↗
PubMed1999

An unusual cause of hemifacial spasm.

Hemifacial spasm (HFS) is a movement disorder characterized by involuntary paroxysmal chronic contractions of the facial musculature. The usual cause is vascular compression of the seventh cranial nerve, at its exit zone from the brain stem. We report a case of left hemifacial spasm, in a 66-year-old woman, in which the neuroradiological investigation with magnetic resonance imaging showed a hypervascular soft tissue mass arising from the left skull base, in the jugular foramen. This lesion was thought highly likely to be a glomus jugulare tumour. While the usual occurrence of tumour compression causing HFS has been previously recognized, the association of glomus jugulare tumours presenting with HFS has not. The importance of this association is discussed. Copyright 1999 Harcourt Publishers Ltd.

Journal Article↗
PubMed1989

[Coronary artery spasm with anaphylactoid shock due to low-molecular dextran].

An anaphylactoid shock with S-T segment elevation in leads II and III and total AV block developed in an 81-year-old man, soon after starting an infusion of about 10 ml of low-molecular dextran and just before a planned balloon dilatation of the anterior descending branch. The shock state was caused by an angiographically demonstrated spasm of the, previously normal, right coronary artery. Intracoronary injection of 0.3 mg nitroglycerin resolved the spasm within two minutes and the patient's general condition returned to normal.

Aged↗
PubMed1986

Coronary artery spasm. What is its role in ischemic heart disease?

Knowledge of the pathophysiology of myocardial ischemia has been greatly enhanced recently by new information on coronary artery spasm. This phenomenon accounts for the mechanism underlying the attacks of resting chest pain in Prinzmetal's angina and plays a role in almost all aspects of ischemic heart disease. The diagnosis of coronary artery spasm can be made presumptively with noninvasive methods, but definitive documentation is usually obtained in the cardiac catheterization laboratory. The nitrate derivatives and the calcium antagonists provide a safe and effective approach to therapy.

Adrenergic beta-Antagonists↗
PubMed1990

Masseteric muscle spasm as a normal response to suxamethonium.

The myotonic response of the masseter muscles following various doses of suxamethonium was measured using a unique myotonometer in 50 apparently healthy patients, the majority of whom showed a myotonic response which lasted less than 100 s. A maximum increase in masseter tone was found to be greater than 1 kg in five patients, and 12 patients developed a maximum tone of greater than 500 g. An increased masseter tone of this degree might be interpreted as "masseteric muscle spasm" by the anaesthetist. The value of masseteric muscle "spasm" as an early sign of malignant hyperthermia is questioned.

Adult↗
PubMed1994

Enhanced coronary vasoconstriction in the Syrian myopathic hamster supports the microvascular spasm hypothesis.

OBJECTIVE: The heart of the young Syrian cardiomyopathic hamster (CMH) displays discrete patches of active myocytolytic necrosis and it has been hypothesised that these lesions are triggered by arteriolar spasm. Accordingly, we tested the theory that the coronary vasoconstrictor response to arginine vasopressin (AVP) infusion is more vigorous in the actively necrotising young (2-3 month old) CMH than in age matched normal hamsters, 5-6 month old CMHs in the histologically quiescent phase of the disease, or 5-6 month old normal hamsters. METHODS: An isovolumetric isolated heart preparation was used in which the coronary arteries were perfused with Krebs-Henseleit buffer at constant flow by a syringe pump. Coronary vascular resistance was determined by the ratio of measured perfusion pressure to flow rate during extended diastoles. RESULTS: There were no significant differences in baseline coronary vascular resistance among the four groups. The increase in resistance with AVP infusion (0.54 pressor units.min-1) was significantly greater (p < 0.01) in the young CMH [6.66(SEM 4.75) mm Hg.ml-1.min-1] than in the old CMH [1.66(0.78)], the young normal [1.10(1.07)], and the old normal [2.72(1.86)] groups. CONCLUSIONS: There is increased vasoconstrictive responsiveness in the young CMH coronary vasculature. The results suggest a broader coronary abnormality in this myopathic model and are consistent with the microvascular spasm hypothesis of myocytolytic lesion formation.

Aging↗
PubMed1996

Coronary artery spasm in patients with normal or near normal coronary arteries. Long-term follow-up of 277 patients.

Most studies on the natural course of coronary artery spasm in patients with normal or nearly normal coronary arteries are based on medium-term follow-up in small populations. The present series includes 277 successive patients with a median follow-up of 89 months (range: 1 to 198 months). There were 206 men and 71 women whose mean age was 53.6 +/- 9.3 years. They were all assessed with coronary arteriography which revealed no stenoses greater than 50%. Spasm was confirmed during the coronary arteriography in 157 patients (56.7%), by a positive provocation test following the arteriography in 113 patients (40.8%), and by an electrocardiogram which showed Prinzmetal's variant angina in seven patients (2.5%). The majority of patients, 264 (95.3%) were treated with calcium channel blockers. At the end of this study: 35 patients (12.6%) were lost to follow-up; 20 patients (7.2% died) including 10 (3.6%) from cardiac causes; 18 patients (6.5%) experienced myocardial infarction in 11 of whom repeat coronary arteriography consistently demonstrated one or more significant stenoses (greater than 70%); 109 patients (39%) had persistent angina, in 52 of whom the severity (more than one episode per month) warranted repeat coronary arteriography which detected significant stenosis in 19 cases; 95 patients (34.3%) were asymptomatic. Multivariate statistical analyses showed that only predictors of major coronary events (death, myocardial infarction or angina requiring repeat coronary arteriography) were systemic hypertension or the finding of minor parietal irregularities on the initial coronary arteriogram. Conclusion. Despite treatment with calcium channel blockers, persistent or recurrent episodes of angina are frequently observed whereas complications such as myocardial infarction or death are rare.

Adult↗
PubMed1991

Coronary artery spasm induced by 5-fluorouracil.

We report a case of coronary artery spasm induced by 5-fluorouracil. The symptoms occurred during continuous intravenous infusion of the drug, and a coronary spasm was visualized at angiography.

Aged↗