BACKGROUND Although the spasm provocation test(SPT)can diagnose coronary spasms,it would be helpful if it could also predict their occurrence.AIM To investigate whether coronary spasms can be predicted using changes i...BACKGROUND Although the spasm provocation test(SPT)can diagnose coronary spasms,it would be helpful if it could also predict their occurrence.AIM To investigate whether coronary spasms can be predicted using changes in intracoronary artery pressure measured using a pressure wire during the SPT.METHODS Seventy patients underwent SPTs with pressure-wire measurement of intracoronary artery pressure.During each SPT,the pressure wire was advanced into the distal portion of the right coronary artery(RCA)and left anterior descending coronary artery,and the ratio of intracoronary pressure to aortic pressure(Pd/Pa)was monitored.Coronary spasm was defined as an arterial narrowing of>90%in response to the administration of acetylcholine(ACh),with chest symptoms and/or ischemic electrocardiographic changes.ACh was administered to the RCA at low,moderate,or high doses of 20,50,or 80μg,respectively,and to the left coronary artery(LCA)at low,moderate,or high doses of 50,100,or 200μg,respectively.Coronary arteries with coronary spasms at low doses of ACh were defined as group L,and those with coronary spasms at moderate or high doses were defined as group MH.Those who did not occur coronary spasms at any ACh dose were designated as group N.RESULTS Among the 132 coronary arteries assessed using a pressure wire,there were 49 in group N,25 in group L,and 58 in group MH.Baseline Pd/Pa was the lowest in group L(P=0.001).The decrease in the Pd/Pa between baseline to low doses of ACh was lower in group MH than in group N(P<0.001).A receiver-operating characteristics analysis showed that the cutoff baseline Pd/Pa value for predicting group L was 0.95,with a sensitivity of 0.600(15/25)and a specificity of 0.713(76/107)and that the cutoff value of Pd/Pa from baseline to low doses of ACh for predicting group MH was−0.04,with a sensitivity of 0.741(43/58)and a specificity of 0.694(34/49).CONCLUSION These findings suggest that indices of intracoronary pressure during SPT may be useful means for predicting the occurrence of coronary spasms.展开更多
Coronary spasm is caused by a transient coronary nar -rowing due to the constriction of epicardial coronary artery, which leads to myocardial ischemia. More than 50 years have passed since the first recognition of cor...Coronary spasm is caused by a transient coronary nar -rowing due to the constriction of epicardial coronary artery, which leads to myocardial ischemia. More than 50 years have passed since the first recognition of coronary spasm, and many findings on coronary spasm have been reported. Coronary spasm has been considered as having pivotal roles in the cause of not only rest angina but also exertional angina, acute coronary syndrome, and heart failure. In addition, several new findings of the mechanism of coronary spasm have emerged recently. The diagnosis based mainly on coronary angiography and spasm provo-cation test and the mainstream treatment with a focus on a calcium-channel blocker have been established. At a glance, coronary spasm or vasospastic angina(VSA) has become a common disease. On the contrary, there are several uncertain or unsolved problems regarding coronary spasm, including the presence of medically refractory coronary spasm(intractable VSA), or an appropriate use of implantable cardioverter defibrillator in patients with cardiac arrest who have been confirmed as having coronary spasm. This editorial focused on coronary spasm, including recent topics and unsolved problems.展开更多
Hyperthyroidism is associated with many heart diseases.Thyrotoxic state has a relationship with coronary spasm.We present a case of a non-menopausal woman with hyperthyroidism who complained of chest pain.The diagnosi...Hyperthyroidism is associated with many heart diseases.Thyrotoxic state has a relationship with coronary spasm.We present a case of a non-menopausal woman with hyperthyroidism who complained of chest pain.The diagnosis of coronary spasm was confirmed by coronary angiography(CAG).She is treated well with anti-thyrotoxicosis and anti-anginal medication.We recommend not use CAG as the first diagnostic choice among the patients with medication-uncontrolled hyperthyroidism and chest pain.展开更多
Introduction: Myocardial infarction with nonobstructive coronary arteries disease (MINOCA) encompasses a heterogeneous group of disorders. Multimodality imaging is crucial to figure out the underlying mechanism. Coron...Introduction: Myocardial infarction with nonobstructive coronary arteries disease (MINOCA) encompasses a heterogeneous group of disorders. Multimodality imaging is crucial to figure out the underlying mechanism. Coronary artery spasm is a common cause of MINOCA and might be difficult to identify. Case Presentation: A 43-year-old male with no cardiovascular risk factor presented with prolonged acute chest pain at 5 am that resolved spontaneously. On admission, he was asymptomatic and clinical findings were unremarkable. The electrocardiogram showed an anterolateral negative T wave. The troponin was positive. Coronary angiography (CA) revealed a moderate lesion of the proximal left anterior descending (LAD) coronary artery. He was treated with dual antiplatelet therapy, statin, and beta-blocker with a favourable hospital course. One week later, he presented chest pain recurrences with anterior ST-segment elevation. CA, without intra-radial nitrate, owing to a vasospasm suspicion, showed a sub-occlusion of the proximal LAD which resolved after intracoronary nitrates. Chest pain and ST-segment elevation then disappeared. He remained asymptomatic and was discharged on CCB (calcium channel blocker), long-acting nitrates dual antiplatelet and statin. Cardiac magnetic resonance (CMR) demonstrated an ejection fraction (EF) of 45% with anterior ischemia. Conclusion: Our case is about a common cause of MINOCA, namely coronary spasm, diagnosed by coronary angiogram without provocative test.展开更多
BACKGROUND Coronary artery spasm(CAS)is a rare but critical condition during surgery.Clinical manifestations can vary from only subtle electrocardiography change to sudden death.In this case report,we present the case...BACKGROUND Coronary artery spasm(CAS)is a rare but critical condition during surgery.Clinical manifestations can vary from only subtle electrocardiography change to sudden death.In this case report,we present the case of a patient with myasthenia gravis(MG)who developed refractory CAS-related cardiogenic shock during thymoma surgery.CASE SUMMARY A 61-year-old man had a history of cigarette smoking and coronary artery disease with a bare metal stent placed.Three months ago,he suffered from coronary spasms,with three vessels involved,after surgery for cervical spine injury.He started having progressive dysphagia 4 wk prior and was diagnosed with MG via serologic tests,and computed tomography declared a thymoma in the anterior mediastinum.After the symptoms of MG subsided,he was referred for thy-mectomy.The operation was uneventful until the closing of the sternal wound.Electrocardiography showed sudden onset ST elevation,followed by ventricular tachycardia and severe hypotension.Cardiopulmonary cerebral resuscitation was initiated immediately with electrical defibrillation,extracorporeal membrane oxygenation was performed due to refractory cardiogenic shock,and the patient was transferred to an angiography room.Angiography showed diffuse CAS with three vessels involved.Intracoronary isosorbide dinitrate and adenosine were administered,and then the patient was transferred to the intensive care unit.CONCLUSION Our case highlights the importance of being prepared for clinical situations such as the one described here and suggests the necessity of developing an appropriate anesthesia plan that includes proactive analgesia and preemptive coronary vaso-dilators.展开更多
Objective This coronary artery spasm review aimed to explore the most possible pathogenic trigger mechanism of vulnerable plaque rupture. Data sources Data used in this coronary artery spasm review were mainly from Me...Objective This coronary artery spasm review aimed to explore the most possible pathogenic trigger mechanism of vulnerable plaque rupture. Data sources Data used in this coronary artery spasm review were mainly from Medline and Pubmed in English. Study selection These reports from major review on coronary artery spasm .and these research included coronary artery conception, pathogenesis of spasm, mechanisms of plaque rupture, epidemiological evidence, clinical manifestation and the relationship between coronary artery spasm and vulnerable plaque rupture. Results Coronary artery spasm is somehow related to the presence of atherosclerotic intima disease in the coronary artery. However, chronic low-grade inflammation causes coronary vessel smooth muscle cell hypersensitivity, which can directely cause coronary artery spasm. Myocardial infarction and sudden cardiac death may be initiated by a sudden intense localized contraction of coronary artery smooth muscle. Conclusion Coronary artery spasm may be one trigger that can initiate and exacerbate vulnerable plaque rupture.展开更多
BACKGROUND Acute stent thrombosis(AST)is a serious complication of percutaneous coronary intervention(PCI).The causes of AST include the use of stents of inappropriate diameters,multiple overlapping stents,or excessiv...BACKGROUND Acute stent thrombosis(AST)is a serious complication of percutaneous coronary intervention(PCI).The causes of AST include the use of stents of inappropriate diameters,multiple overlapping stents,or excessively long stents;incomplete stent expansion;poor stent adhesion;incomplete coverage of dissection;formation of thrombosis or intramural hematomas;vascular injury secondary to intraoperative mechanical manipulation;insufficient dose administration of postoperative antiplatelet medications;and resistance to antiplatelet drugs.Cases of AST secondary to coronary artery spasms are rare,with only a few reports in the literature.CASE SUMMARY A 55-year-old man was admitted to the hospital with a chief complaint of back pain for 2 d.He was diagnosed with coronary heart disease and acute myocardial infarction(AMI)based on electrocardiography results and creatinine kinase myocardial band,troponin I,and troponin T levels.A 2.5 mm×33.0 mm drugeluting stent was inserted into the occluded portion of the right coronary artery.Aspirin,clopidogrel,and atorvastatin were started.Six days later,the patient developed AST after taking a bath in the morning.Repeat coronary angiography showed occlusion of the proximal stent,and intravascular ultrasound showed severe coronary artery spasms.The patient’s AST was thought to be caused by coronary artery spasms and treated with percutaneous transluminal coronary angioplasty.Postoperatively,he was administered diltiazem to inhibit coronary artery spasms and prevent future episodes of AST.He survived and reported no discomfort at the 2-mo follow-up after the operation and initiation of drug treatment.CONCLUSION Coronary spasms can cause both AMI and AST.For patients who exhibit coronary spasms during PCI,diltiazem administration could reduce spasms and prevent future AST.展开更多
CASE REPORT Acute myocardial infarction （AMI） is usually caused by atherosclerotic plaque disruption and thrombus formation. However, AMI is occasionally caused by coronary spasm too. We are reporting a case with AM...CASE REPORT Acute myocardial infarction （AMI） is usually caused by atherosclerotic plaque disruption and thrombus formation. However, AMI is occasionally caused by coronary spasm too. We are reporting a case with AMI due to coronary spasm whose serial electrocardiogram （ECG） showed dynamic changes of T waves in precordial leads.展开更多
BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia.Although coronary artery spasm has been known for a long time,its mechanism has not yet been identified.Many clinicians,especially young clinici...BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia.Although coronary artery spasm has been known for a long time,its mechanism has not yet been identified.Many clinicians,especially young clinicians pay less attention to coronary artery spasm,which may lead to some patients not being appropriately diagnosed and treated in time.We report a patient with spontaneous multivessel coronary artery spasm for more than 30 years diagnosed with intravascular ultrasound(IVUS)imaging.CASE SUMMARY A 66-year-old Chinese male patient had chest squeezing at rest for more than 30 years.He had a history of cigarette smoking for more than 40 years and hypertension for 10 years.Before presenting at our institution,the patient had undergone coronary angiography 4 times and percutaneous transluminal coronary angioplasty procedures twice at other hospitals without a diagnosis of coronary artery spasm.However,his chest symptoms worsened.Spontaneous multivessel coronary artery spasm occurred during IVUS without provocation testing,and the IVUS image was recorded.Thus,the diagnosis of multifocal spontaneous coronary artery spasm was confirmed.The patient was placed on oral diltiazem,isosorbide mononitrate,and nicorandil to suppress coronary artery spasms.All medications were given at the maximum dosages tolerated by the patient.He was discharged after 5 d without complications.During the six-month follow-up period,the patient was symptom-free.CONCLUSION Coronary artery spasm is still prevalent in Eastern countries.It is essential for clinicians to be aware of coronary artery spasm,which may be hard to detect and can be lethal,in order to diagnose and treat patients appropriately.展开更多
Coronary artery spasm （CAS） is found not only in Asian but also in white patients. CAS can lead to angina pecto- ris, myocardial infarction, ventricular arrhythmias and sud- den cardiac death. But CAS diagnosis is n...Coronary artery spasm （CAS） is found not only in Asian but also in white patients. CAS can lead to angina pecto- ris, myocardial infarction, ventricular arrhythmias and sud- den cardiac death. But CAS diagnosis is not necessarily easy, and it also remains highly challenging to therapy and prevention. We present a spontaneous extensive-CAS case with typical clinical features of acute myocardial infarction, despite the regular vasodilator treatment.展开更多
Coronary artery spasm （CAS） is one of the leading pathological causes of a wide spectrum of ischemic heart diseases, ranging from variant angina pectoris to acute myocardial infarction and even sudden cardiac death[...Coronary artery spasm （CAS） is one of the leading pathological causes of a wide spectrum of ischemic heart diseases, ranging from variant angina pectoris to acute myocardial infarction and even sudden cardiac death[1]. Furthermore, Pierron et al. concluded that CAS of angiographically normal or sub-normal arteries is responsible for death or myocardial infarction in 11.6% of all cases. Oddly, the incidence of CAS is remarkably higher in Asians than in Caucasians[3], suggesting genetic involvement In its pathogenesis.展开更多
The spasm provocation test(SPT) is an important test in the diagnosis of vasospastic angina(VSA). In many cases, this test is performed as the gold standard test, and VSA is considered not present if the SPT is negati...The spasm provocation test(SPT) is an important test in the diagnosis of vasospastic angina(VSA). In many cases, this test is performed as the gold standard test, and VSA is considered not present if the SPT is negative. However, some patients continue to experience chest symptoms despite a negative SPT. In this study, we report four cases in which SPT was repeated to evaluate chest symptoms despite the negative results of the first SPT. Two men in their 70 s, one woman in her 60 s, and one woman in her 70 s, all with chest symptoms, underwent a second SPT at 4, 3, 2, and 3 years, respectively, after the first SPT, which was negative. Three patients had positive results in the second SPT(75%). In conclusion, even when SPT is negative, the diagnosis of VSA should be made with clinical symptoms in consideration. In some cases, a second SPT may be required to confirm the diagnosis of VSA.展开更多
BACKGROUND Acute myocardial infarction(AMI)during pregnancy is rare,especially in twin pregnancy,and it can endanger the lives of the mother and children.Except for conventional cardiovascular risk factors,pregnancy a...BACKGROUND Acute myocardial infarction(AMI)during pregnancy is rare,especially in twin pregnancy,and it can endanger the lives of the mother and children.Except for conventional cardiovascular risk factors,pregnancy and assisted reproduction can increase the risk of AMI during pregnancy.AMI develops secondary to different etiologies,such as coronary spasm and spontaneous coronary artery dissection.CASE SUMMARY A 33-year-old woman,with twin pregnancy in the 31st week of gestation,presented to the hospital with intermittent chest tightness for 12 wk,aggravation for 1 wk,and chest pain for 4 h.Combined with the electrocardiogram and hypersensitive troponin results,she was diagnosed with acute ST-elevation myocardial infarction.Although the patient had no related medical history,she presented several risk factors,such as age greater than 30 years,assisted reproduction,and hyperlipidemia.After diagnosis,the patient received antiplatelet and anticoagulant treatment.Cesarean section and coronary angiography performed 7 d later showed stenosis and thrombus shadow of the right coronary artery.After receiving medication,the patient was in good condition.CONCLUSION This case suggests that,with the widespread use of assisted reproductive technology,more attention should be paid to perinatal healthcare,especially when chest pain occurs,to facilitate early diagnosis and intervention of AMI,and the etiology of AMI in pregnancy needs to be differentiated,especially between coronary spasm and spontaneous coronary artery dissection.展开更多
Coronary artery spasm can cause recurrent variant angina with ST-segment elevation.The patient was asymptomatic with normal vitals and ECG was normal.We present a case associated with transient ST-segment elevation an...Coronary artery spasm can cause recurrent variant angina with ST-segment elevation.The patient was asymptomatic with normal vitals and ECG was normal.We present a case associated with transient ST-segment elevation and signifi-cant increase in troponin levels with non-critical lesion with normal CAG.展开更多
Coronary artery spasm is typically a transient and marked narrowing of a single coronary artery lumen that induces myocardial ischemia.In general,patients with coronary spastic angina have a good prognosis.Herein,we d...Coronary artery spasm is typically a transient and marked narrowing of a single coronary artery lumen that induces myocardial ischemia.In general,patients with coronary spastic angina have a good prognosis.Herein,we described a case of recurrent diffuse multivessel coronary artery spasm presented as myocardial infarction,which was a very rare form of coronary heart disease.Although several similar ones have been reported worldwide,this is the first case rechecked by coronary angiography （CAG） in the follow-up period.展开更多
Background:We report an acute emotional stress-induced in-hospital cardiac arrest in a patient admitted with gas-trointestinal symptoms after experiencing chronic anxiety disorder.Case Presentation:The patient was adm...Background:We report an acute emotional stress-induced in-hospital cardiac arrest in a patient admitted with gas-trointestinal symptoms after experiencing chronic anxiety disorder.Case Presentation:The patient was admitted to the Second Xiangya Hospital,Central South University,with gastrointestinal symptoms and chronic anxiety disorder,and experienced cardiac arrest during hospitalization after acute emotional stress.Malignant ventricular tachycardia and cardiogenic shock were evidenced in this patient after the acute emotional stress.Severe and extensive coronary spasm was confi rmed by emergency coronary angiography,and coronary spasm was relieved by intracoronary injection of nitroglycerin.The patient recovered from myocardial infarction with nonobstructive coronary arteries.However,the patient developed acute kidney dysfunction and severe pulmonary infection and eventually died of respiratory circulatory failure on the ninth day after the successful rescue.Conclusions:Acute emotional stress on top of chronic anxiety disorder in patients hospitalized for noncardiovascu-lar reasons might lead to the development of life-threatening cardiovascular diseases,including coronary artery spasm and myocardial infarction with nonobstructive coronary arteries.Psychological management is of importance to im-prove the outcome of these patients.展开更多
Background Spontaneous attack of variant angina （VA） is a unique component of coronary artery disease （CAD）, and associated with severe cardiac events. However, no data are available regarding sex differences in C...Background Spontaneous attack of variant angina （VA） is a unique component of coronary artery disease （CAD）, and associated with severe cardiac events. However, no data are available regarding sex differences in Chinese patients with spontaneous attacks of VA. Accordingly, the present retrospective study was initiated to evaluate the Clinical characteristics of Chinese female patients with spontaneous attacks of VA. Methods From January 2003 to January 2008, a total of 209 patients were diagnosed to have had a spontaneous attack of VA at Fu Wai Hospital. Of them, 27 were female, and their clinical findings were collected and compared with male patients for aspects of risk factors, clinical features and angiographical findings. Results Spontaneous attacks of VA was relatively uncommon in female （12.9%） compared with male patients. The female patients were less likely to have a history of smoking （14.8% vs. 79.7%, P 〈0.001）, more likely to have a family history of CAD （33.3% vs. 11.0%, P 〈0.01）, and to have had a greater incidence of ventricular fibrillation during attack （11.1% vs. 2.2%, P 〈0.05）. There were no significant differences in other characteristics between the two groups. Conclusion Chinese female patients who experienced a spontaneous attack of VA had the characteristics of less smokina history, more family history of CAD and higher occurrence of ventricular fibrillation than male patients.展开更多
文摘BACKGROUND Although the spasm provocation test(SPT)can diagnose coronary spasms,it would be helpful if it could also predict their occurrence.AIM To investigate whether coronary spasms can be predicted using changes in intracoronary artery pressure measured using a pressure wire during the SPT.METHODS Seventy patients underwent SPTs with pressure-wire measurement of intracoronary artery pressure.During each SPT,the pressure wire was advanced into the distal portion of the right coronary artery(RCA)and left anterior descending coronary artery,and the ratio of intracoronary pressure to aortic pressure(Pd/Pa)was monitored.Coronary spasm was defined as an arterial narrowing of>90%in response to the administration of acetylcholine(ACh),with chest symptoms and/or ischemic electrocardiographic changes.ACh was administered to the RCA at low,moderate,or high doses of 20,50,or 80μg,respectively,and to the left coronary artery(LCA)at low,moderate,or high doses of 50,100,or 200μg,respectively.Coronary arteries with coronary spasms at low doses of ACh were defined as group L,and those with coronary spasms at moderate or high doses were defined as group MH.Those who did not occur coronary spasms at any ACh dose were designated as group N.RESULTS Among the 132 coronary arteries assessed using a pressure wire,there were 49 in group N,25 in group L,and 58 in group MH.Baseline Pd/Pa was the lowest in group L(P=0.001).The decrease in the Pd/Pa between baseline to low doses of ACh was lower in group MH than in group N(P<0.001).A receiver-operating characteristics analysis showed that the cutoff baseline Pd/Pa value for predicting group L was 0.95,with a sensitivity of 0.600(15/25)and a specificity of 0.713(76/107)and that the cutoff value of Pd/Pa from baseline to low doses of ACh for predicting group MH was−0.04,with a sensitivity of 0.741(43/58)and a specificity of 0.694(34/49).CONCLUSION These findings suggest that indices of intracoronary pressure during SPT may be useful means for predicting the occurrence of coronary spasms.
文摘Coronary spasm is caused by a transient coronary nar -rowing due to the constriction of epicardial coronary artery, which leads to myocardial ischemia. More than 50 years have passed since the first recognition of coronary spasm, and many findings on coronary spasm have been reported. Coronary spasm has been considered as having pivotal roles in the cause of not only rest angina but also exertional angina, acute coronary syndrome, and heart failure. In addition, several new findings of the mechanism of coronary spasm have emerged recently. The diagnosis based mainly on coronary angiography and spasm provo-cation test and the mainstream treatment with a focus on a calcium-channel blocker have been established. At a glance, coronary spasm or vasospastic angina(VSA) has become a common disease. On the contrary, there are several uncertain or unsolved problems regarding coronary spasm, including the presence of medically refractory coronary spasm(intractable VSA), or an appropriate use of implantable cardioverter defibrillator in patients with cardiac arrest who have been confirmed as having coronary spasm. This editorial focused on coronary spasm, including recent topics and unsolved problems.
文摘Hyperthyroidism is associated with many heart diseases.Thyrotoxic state has a relationship with coronary spasm.We present a case of a non-menopausal woman with hyperthyroidism who complained of chest pain.The diagnosis of coronary spasm was confirmed by coronary angiography(CAG).She is treated well with anti-thyrotoxicosis and anti-anginal medication.We recommend not use CAG as the first diagnostic choice among the patients with medication-uncontrolled hyperthyroidism and chest pain.
文摘Introduction: Myocardial infarction with nonobstructive coronary arteries disease (MINOCA) encompasses a heterogeneous group of disorders. Multimodality imaging is crucial to figure out the underlying mechanism. Coronary artery spasm is a common cause of MINOCA and might be difficult to identify. Case Presentation: A 43-year-old male with no cardiovascular risk factor presented with prolonged acute chest pain at 5 am that resolved spontaneously. On admission, he was asymptomatic and clinical findings were unremarkable. The electrocardiogram showed an anterolateral negative T wave. The troponin was positive. Coronary angiography (CA) revealed a moderate lesion of the proximal left anterior descending (LAD) coronary artery. He was treated with dual antiplatelet therapy, statin, and beta-blocker with a favourable hospital course. One week later, he presented chest pain recurrences with anterior ST-segment elevation. CA, without intra-radial nitrate, owing to a vasospasm suspicion, showed a sub-occlusion of the proximal LAD which resolved after intracoronary nitrates. Chest pain and ST-segment elevation then disappeared. He remained asymptomatic and was discharged on CCB (calcium channel blocker), long-acting nitrates dual antiplatelet and statin. Cardiac magnetic resonance (CMR) demonstrated an ejection fraction (EF) of 45% with anterior ischemia. Conclusion: Our case is about a common cause of MINOCA, namely coronary spasm, diagnosed by coronary angiogram without provocative test.
文摘BACKGROUND Coronary artery spasm(CAS)is a rare but critical condition during surgery.Clinical manifestations can vary from only subtle electrocardiography change to sudden death.In this case report,we present the case of a patient with myasthenia gravis(MG)who developed refractory CAS-related cardiogenic shock during thymoma surgery.CASE SUMMARY A 61-year-old man had a history of cigarette smoking and coronary artery disease with a bare metal stent placed.Three months ago,he suffered from coronary spasms,with three vessels involved,after surgery for cervical spine injury.He started having progressive dysphagia 4 wk prior and was diagnosed with MG via serologic tests,and computed tomography declared a thymoma in the anterior mediastinum.After the symptoms of MG subsided,he was referred for thy-mectomy.The operation was uneventful until the closing of the sternal wound.Electrocardiography showed sudden onset ST elevation,followed by ventricular tachycardia and severe hypotension.Cardiopulmonary cerebral resuscitation was initiated immediately with electrical defibrillation,extracorporeal membrane oxygenation was performed due to refractory cardiogenic shock,and the patient was transferred to an angiography room.Angiography showed diffuse CAS with three vessels involved.Intracoronary isosorbide dinitrate and adenosine were administered,and then the patient was transferred to the intensive care unit.CONCLUSION Our case highlights the importance of being prepared for clinical situations such as the one described here and suggests the necessity of developing an appropriate anesthesia plan that includes proactive analgesia and preemptive coronary vaso-dilators.
文摘Objective This coronary artery spasm review aimed to explore the most possible pathogenic trigger mechanism of vulnerable plaque rupture. Data sources Data used in this coronary artery spasm review were mainly from Medline and Pubmed in English. Study selection These reports from major review on coronary artery spasm .and these research included coronary artery conception, pathogenesis of spasm, mechanisms of plaque rupture, epidemiological evidence, clinical manifestation and the relationship between coronary artery spasm and vulnerable plaque rupture. Results Coronary artery spasm is somehow related to the presence of atherosclerotic intima disease in the coronary artery. However, chronic low-grade inflammation causes coronary vessel smooth muscle cell hypersensitivity, which can directely cause coronary artery spasm. Myocardial infarction and sudden cardiac death may be initiated by a sudden intense localized contraction of coronary artery smooth muscle. Conclusion Coronary artery spasm may be one trigger that can initiate and exacerbate vulnerable plaque rupture.
基金Supported by the National Natural Science Foundation of China,No. 82000252
文摘BACKGROUND Acute stent thrombosis(AST)is a serious complication of percutaneous coronary intervention(PCI).The causes of AST include the use of stents of inappropriate diameters,multiple overlapping stents,or excessively long stents;incomplete stent expansion;poor stent adhesion;incomplete coverage of dissection;formation of thrombosis or intramural hematomas;vascular injury secondary to intraoperative mechanical manipulation;insufficient dose administration of postoperative antiplatelet medications;and resistance to antiplatelet drugs.Cases of AST secondary to coronary artery spasms are rare,with only a few reports in the literature.CASE SUMMARY A 55-year-old man was admitted to the hospital with a chief complaint of back pain for 2 d.He was diagnosed with coronary heart disease and acute myocardial infarction(AMI)based on electrocardiography results and creatinine kinase myocardial band,troponin I,and troponin T levels.A 2.5 mm×33.0 mm drugeluting stent was inserted into the occluded portion of the right coronary artery.Aspirin,clopidogrel,and atorvastatin were started.Six days later,the patient developed AST after taking a bath in the morning.Repeat coronary angiography showed occlusion of the proximal stent,and intravascular ultrasound showed severe coronary artery spasms.The patient’s AST was thought to be caused by coronary artery spasms and treated with percutaneous transluminal coronary angioplasty.Postoperatively,he was administered diltiazem to inhibit coronary artery spasms and prevent future episodes of AST.He survived and reported no discomfort at the 2-mo follow-up after the operation and initiation of drug treatment.CONCLUSION Coronary spasms can cause both AMI and AST.For patients who exhibit coronary spasms during PCI,diltiazem administration could reduce spasms and prevent future AST.
文摘CASE REPORT Acute myocardial infarction （AMI） is usually caused by atherosclerotic plaque disruption and thrombus formation. However, AMI is occasionally caused by coronary spasm too. We are reporting a case with AMI due to coronary spasm whose serial electrocardiogram （ECG） showed dynamic changes of T waves in precordial leads.
文摘BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia.Although coronary artery spasm has been known for a long time,its mechanism has not yet been identified.Many clinicians,especially young clinicians pay less attention to coronary artery spasm,which may lead to some patients not being appropriately diagnosed and treated in time.We report a patient with spontaneous multivessel coronary artery spasm for more than 30 years diagnosed with intravascular ultrasound(IVUS)imaging.CASE SUMMARY A 66-year-old Chinese male patient had chest squeezing at rest for more than 30 years.He had a history of cigarette smoking for more than 40 years and hypertension for 10 years.Before presenting at our institution,the patient had undergone coronary angiography 4 times and percutaneous transluminal coronary angioplasty procedures twice at other hospitals without a diagnosis of coronary artery spasm.However,his chest symptoms worsened.Spontaneous multivessel coronary artery spasm occurred during IVUS without provocation testing,and the IVUS image was recorded.Thus,the diagnosis of multifocal spontaneous coronary artery spasm was confirmed.The patient was placed on oral diltiazem,isosorbide mononitrate,and nicorandil to suppress coronary artery spasms.All medications were given at the maximum dosages tolerated by the patient.He was discharged after 5 d without complications.During the six-month follow-up period,the patient was symptom-free.CONCLUSION Coronary artery spasm is still prevalent in Eastern countries.It is essential for clinicians to be aware of coronary artery spasm,which may be hard to detect and can be lethal,in order to diagnose and treat patients appropriately.
文摘Coronary artery spasm （CAS） is found not only in Asian but also in white patients. CAS can lead to angina pecto- ris, myocardial infarction, ventricular arrhythmias and sud- den cardiac death. But CAS diagnosis is not necessarily easy, and it also remains highly challenging to therapy and prevention. We present a spontaneous extensive-CAS case with typical clinical features of acute myocardial infarction, despite the regular vasodilator treatment.
基金supported by fund from Guangdong Natural Science Foundation (No. 9251001002000002)
文摘Coronary artery spasm （CAS） is one of the leading pathological causes of a wide spectrum of ischemic heart diseases, ranging from variant angina pectoris to acute myocardial infarction and even sudden cardiac death[1]. Furthermore, Pierron et al. concluded that CAS of angiographically normal or sub-normal arteries is responsible for death or myocardial infarction in 11.6% of all cases. Oddly, the incidence of CAS is remarkably higher in Asians than in Caucasians[3], suggesting genetic involvement In its pathogenesis.
文摘The spasm provocation test(SPT) is an important test in the diagnosis of vasospastic angina(VSA). In many cases, this test is performed as the gold standard test, and VSA is considered not present if the SPT is negative. However, some patients continue to experience chest symptoms despite a negative SPT. In this study, we report four cases in which SPT was repeated to evaluate chest symptoms despite the negative results of the first SPT. Two men in their 70 s, one woman in her 60 s, and one woman in her 70 s, all with chest symptoms, underwent a second SPT at 4, 3, 2, and 3 years, respectively, after the first SPT, which was negative. Three patients had positive results in the second SPT(75%). In conclusion, even when SPT is negative, the diagnosis of VSA should be made with clinical symptoms in consideration. In some cases, a second SPT may be required to confirm the diagnosis of VSA.
基金National Natural Science Foundation of China,No.81900641.
文摘BACKGROUND Acute myocardial infarction(AMI)during pregnancy is rare,especially in twin pregnancy,and it can endanger the lives of the mother and children.Except for conventional cardiovascular risk factors,pregnancy and assisted reproduction can increase the risk of AMI during pregnancy.AMI develops secondary to different etiologies,such as coronary spasm and spontaneous coronary artery dissection.CASE SUMMARY A 33-year-old woman,with twin pregnancy in the 31st week of gestation,presented to the hospital with intermittent chest tightness for 12 wk,aggravation for 1 wk,and chest pain for 4 h.Combined with the electrocardiogram and hypersensitive troponin results,she was diagnosed with acute ST-elevation myocardial infarction.Although the patient had no related medical history,she presented several risk factors,such as age greater than 30 years,assisted reproduction,and hyperlipidemia.After diagnosis,the patient received antiplatelet and anticoagulant treatment.Cesarean section and coronary angiography performed 7 d later showed stenosis and thrombus shadow of the right coronary artery.After receiving medication,the patient was in good condition.CONCLUSION This case suggests that,with the widespread use of assisted reproductive technology,more attention should be paid to perinatal healthcare,especially when chest pain occurs,to facilitate early diagnosis and intervention of AMI,and the etiology of AMI in pregnancy needs to be differentiated,especially between coronary spasm and spontaneous coronary artery dissection.
基金the Natural Science Foundation of Shandong Province(ZR2017BH114)the National Natural Science Foundation of China(81700334)Jinan Science and Technology Plan Project(201805058).
文摘Coronary artery spasm can cause recurrent variant angina with ST-segment elevation.The patient was asymptomatic with normal vitals and ECG was normal.We present a case associated with transient ST-segment elevation and signifi-cant increase in troponin levels with non-critical lesion with normal CAG.
文摘Coronary artery spasm is typically a transient and marked narrowing of a single coronary artery lumen that induces myocardial ischemia.In general,patients with coronary spastic angina have a good prognosis.Herein,we described a case of recurrent diffuse multivessel coronary artery spasm presented as myocardial infarction,which was a very rare form of coronary heart disease.Although several similar ones have been reported worldwide,this is the first case rechecked by coronary angiography （CAG） in the follow-up period.
文摘Background:We report an acute emotional stress-induced in-hospital cardiac arrest in a patient admitted with gas-trointestinal symptoms after experiencing chronic anxiety disorder.Case Presentation:The patient was admitted to the Second Xiangya Hospital,Central South University,with gastrointestinal symptoms and chronic anxiety disorder,and experienced cardiac arrest during hospitalization after acute emotional stress.Malignant ventricular tachycardia and cardiogenic shock were evidenced in this patient after the acute emotional stress.Severe and extensive coronary spasm was confi rmed by emergency coronary angiography,and coronary spasm was relieved by intracoronary injection of nitroglycerin.The patient recovered from myocardial infarction with nonobstructive coronary arteries.However,the patient developed acute kidney dysfunction and severe pulmonary infection and eventually died of respiratory circulatory failure on the ninth day after the successful rescue.Conclusions:Acute emotional stress on top of chronic anxiety disorder in patients hospitalized for noncardiovascu-lar reasons might lead to the development of life-threatening cardiovascular diseases,including coronary artery spasm and myocardial infarction with nonobstructive coronary arteries.Psychological management is of importance to im-prove the outcome of these patients.
基金This research was partly supported by grants from Fu Wai Hospital （No. 2004190）, National Natural Science Foundation of China （No. 30670861 and No. 30871055）, Beijing Natural Science Foundation （No. 7082081）, and Specialized Research Fund for the Doctoral Program of High Education of China （No. 20060023044 and No. 20070023047）.
文摘Background Spontaneous attack of variant angina （VA） is a unique component of coronary artery disease （CAD）, and associated with severe cardiac events. However, no data are available regarding sex differences in Chinese patients with spontaneous attacks of VA. Accordingly, the present retrospective study was initiated to evaluate the Clinical characteristics of Chinese female patients with spontaneous attacks of VA. Methods From January 2003 to January 2008, a total of 209 patients were diagnosed to have had a spontaneous attack of VA at Fu Wai Hospital. Of them, 27 were female, and their clinical findings were collected and compared with male patients for aspects of risk factors, clinical features and angiographical findings. Results Spontaneous attacks of VA was relatively uncommon in female （12.9%） compared with male patients. The female patients were less likely to have a history of smoking （14.8% vs. 79.7%, P 〈0.001）, more likely to have a family history of CAD （33.3% vs. 11.0%, P 〈0.01）, and to have had a greater incidence of ventricular fibrillation during attack （11.1% vs. 2.2%, P 〈0.05）. There were no significant differences in other characteristics between the two groups. Conclusion Chinese female patients who experienced a spontaneous attack of VA had the characteristics of less smokina history, more family history of CAD and higher occurrence of ventricular fibrillation than male patients.
