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Variant Angina Pectoris


Presentation

  • Abstract To study whether magnesium (Mg) deficiency is present in patients with variant angina, 24-hour Mg retention of low dose Mg (0.2 mEq/kg lean body weight) administered intravenously over 4 hours in 20 patients with variant angina was examined.[ncbi.nlm.nih.gov]
  • The pharmacology of verapamil relating to the pathogenesis of vasospastic angina is delineated and guidelines for the clinical application of the agent are presented.[ncbi.nlm.nih.gov]
  • Plasma adiponectin concentrations between VAP and other coronary artery diseases was compared in the present study. The association between plasma adiponectin concentration and VAP was also investigated.[ncbi.nlm.nih.gov]
  • In two patients with S-T-elevation anteriorly, severe stenosis of the anterior descending coronary artery was present.[ncbi.nlm.nih.gov]
  • Abstract The present study investigates the prognostic significance of silent myocardial ischemia in variant angina.[ncbi.nlm.nih.gov]
Coronary Artery Disease
  • BACKGROUND: Plasma adiponectin is decreased in patients with coronary artery diseases, especially in patients with acute coronary syndrome (ACS).[ncbi.nlm.nih.gov]
  • Abstract Lipid and apolipoprotein (apo) levels in patients with variant angina were examined and compared with patients with coronary artery disease (CAD) and normal subjects (control).[ncbi.nlm.nih.gov]
  • At initial evaluation, four patients had significant (greater than or equal to 50% fixed coronary diameter reduction) one-vessel coronary artery disease, and six had nonsignificant disease.[ncbi.nlm.nih.gov]
  • Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? ‎ Pagina 1132 - Grines CL, Browne KF, Marco J, et al.[books.google.it]
Falling
  • Two Prinzmetal patients had no provocation of variant angina following methacholine, though they did experience significantly less blood pressure fall in response to muscarinic provocation.[ncbi.nlm.nih.gov]
  • The electrocardiographic changes in the dog preparation were virtually identical to those in the patients and strongly correlated with a fall in myocardial conduction velocity.[ncbi.nlm.nih.gov]
  • Rev Cardiovasc Med. 2010 Fall. 11(4):264-70. [Medline]. Bertrand ME, Lablanche JM, Rousseau MF, Warembourg HH Jr, Stankowtak C, Soots G. Surgical treatment of variant angina: use of plexectomy with aortocoronary bypass.[emedicine.com]
  • Considered together, the above studies strongly suggest that statins seem to improve endothelial dysfunction and suppress coronary spasm. 26 Furthermore, it is also reported that statins therapy results in significant falls in serum levels of CRP, a marker[doi.org]
Oral Ulcers
  • After treatment with immunosuppressant, neither angina nor oral ulcer relapsed. We strongly believe that the variant angina is due to coronary vasospasm induced by Behçet's syndrome in this patient.[ncbi.nlm.nih.gov]
Chest Pain
  • In three patients with vasospastic angina pectoris, chronic amiodarone administered orally at doses of 800 and 1,000 mg/day totally suppressed spontaneous episodes of ischemic chest pain for 8 to 14 months.[ncbi.nlm.nih.gov]
  • In six patients neither histamine nor ergonovine provoked spasm, and these patients were considered by chronic follow-up evaluation to have noncardiac etiology for their chest pain syndrome.[ncbi.nlm.nih.gov]
  • Another 23 subjects with incompletely explained chest pain given methacholine had neither ECG change nor spasm.[ncbi.nlm.nih.gov]
  • We report the case of a 53 year-old male patient with recurrent episodes of chest pain and arrhythmias in the course of related variant angina pectoris.[ncbi.nlm.nih.gov]
  • In contrast to the classical findings, in these patients the attacks of chest pain did not cease after the infarction, but became more frequent and severe.[ncbi.nlm.nih.gov]
Heart Disease
  • Twenty patients with chronic exertional angina, positive exercise test results and coronary heart disease were compared with 14 patients with variant angina and ST-segment elevation during an ergonovine test.[ncbi.nlm.nih.gov]
  • Twenty-one subjects without ischemic heart disease were studied as control subjects.[ncbi.nlm.nih.gov]
  • Join Us For A Heart Walk In Your Area Heart Walk is the American Heart Association's premiere event for raising funds to help save lives from heart disease and stroke.[heart.org]
  • Family history and genetics - Angina Ischemic heart disease often runs in families. Also, people who have no lifestyle-related risk factors can develop ischemic heart disease.[nhlbi.nih.gov]
  • Take steps to reduce your risk of heart disease. This includes not smoking, eating a low-fat diet, and increasing exercise.[nlm.nih.gov]
Retrosternal Chest Pain
  • Fifteen minutes after a renal arteriogram (May 7) was performed, the patient had severe retrosternal chest pain associated with hypotension and bradycardia. Serial ECGs are depicted[jamanetwork.com]
  • Ahmed, MD, Iowa Heart Center, Jennie Edmundson Hospital, Council Bluffs, Iowa Typical anginal symptoms are characterized by recurrent attacks of retrosternal chest pain brought on by effort and emotion, and relieved by rest or by the administration of[cathlabdigest.com]
Ventricular Bigeminy
  • No arrhythmias were observed during ST segment depression, but 26 episodes of ST segment elevation (19%) were associated with arrhythmias: 7 with premature ventricular contractions, 3 with ventricular bigeminy, 3 with complete atrioventricular (AV) block[ncbi.nlm.nih.gov]

Workup

  • Further workup revealed metastatic pheochromocytoma. Conclusion Calcium channel blockers and nitrates which promotes coronary vasodilatation are commonly used in management of prinzmetal angina.[onlinejacc.org]
Calcified Aortic Valve
  • Replacement of the calcified aortic valve resulted in total relief of symptomatology.[ncbi.nlm.nih.gov]
ST Elevation
  • The mean daily number of ST elevation in group 1 was similar to that in group 2 (4.8 /- 5.1 vs 4.1 /- 4.6; p not significant).[ncbi.nlm.nih.gov]
  • All had attacks of chest pain associated with ST elevation on electrocardiograms. Twenty-one subjects without ischemic heart disease were studied as control subjects.[ncbi.nlm.nih.gov]
  • Non-ST elevation acute coronary syndromes. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 53.[nlm.nih.gov]
  • He was started on isosorbide mononitrate and ranolazine but he continued to have nocturnal chest pain with ST elevations and 3 rd degree heart block. Diltiazem and cilostazol were added.[onlinejacc.org]
  • Although variant angina may progress on to ST elevation myocardial infarction, the former is distinguished by a history of recurrent chest pain and prompt response to nitrates.[escardio.org]
Ventricular Bigeminy
  • No arrhythmias were observed during ST segment depression, but 26 episodes of ST segment elevation (19%) were associated with arrhythmias: 7 with premature ventricular contractions, 3 with ventricular bigeminy, 3 with complete atrioventricular (AV) block[ncbi.nlm.nih.gov]
T Wave Inversion
  • Once again, ECGs demonstrated T-wave inversion in V1–3. A repeat test showed that cTnI level was elevated at 0.4 ng/L.[smj.org.sg]
  • Two electrocardiographic patterns with or without transient T-wave inversion during recovery periods of variant anginal attacks. Jpn Circ J. 1983 Dec. 47(12):1415-22. [Medline]. Miwa K, Murakami T, Kambara H, Kawai C.[emedicine.com]
  • If VF is Figure 1 (A) Twelve-lead electrocardiogram in a 50-year-old male showing T-wave inversion in leads I, aVL, V 2-6. (B) Normal electrocardiogram after 6-month treatment with diltiazem.[dx.doi.org]
Ischemic Changes
  • In the rest 201Tl study, septal perfusion was low on the early image, although partial redistribution of this site was observed on the delayed image without the appearance of chest pain or electrocardiographic ischemic change.[ncbi.nlm.nih.gov]

Treatment

  • The consumption of sublingual nitroglycerin tablets decreased significantly in both treatment periods in comparison with the observation period before treatment (p less than 0.01, p less than 0.001, respectively).[ncbi.nlm.nih.gov]
  • Intolerable side effects necessitating cessation of treatment occurred in two patients during nifedipine treatment and in three patients during ISDN treatment.[ncbi.nlm.nih.gov]
  • The frequency of anginal attacks and the consumption of sublingual nitroglycerin tablets decreased significantly in both treatment periods in comparison with those in the observation period before treatment, but in the observation period after treatment[ncbi.nlm.nih.gov]
  • Before treatment, ergonovine maleate 0.2 to 0.4 mg intravenously provoked chest pain and similar ischemic ECG changes as those occurring spontaneously. During amiodarone treatment ergonovine vasoconstriction was totally or partially inhibited.[ncbi.nlm.nih.gov]
  • However, 24-hour Mg retention decreased significantly (p less than 0.01) from 60 /- 6 to 34 /- 7% after the treatment. There is Mg deficiency in many patients with variant angina and it is corrected after treatment with calcium antagonists.[ncbi.nlm.nih.gov]

Prognosis

  • CONCLUSIONS: Although the prognosis of multivessel spasm is believed to be poor, this may not necessarily be so.[ncbi.nlm.nih.gov]
  • Variant angina pectoris may be accompanied by a variety of coronary arteriographic findings and the prognosis appears more favorable than previously reported.[ncbi.nlm.nih.gov]
  • Clinical studies suggest that combination therapy significantly improves the long-term prognosis of patients with variant angina and reduces the need for bypass surgery.[ncbi.nlm.nih.gov]
  • Part I updates the pathophysiology, clinical presentation and prognosis of angina pectoris. Part II aims to put in numbers' the symptoms and signs of myocardial ischemia, starting from a revision of the currently used parameters.[books.google.it]
  • The prognosis of VA and RA in patients with negative U waves was less favorable compared to those without negative U waves. In particular, we noted that of the 10 patients with RA associated with negative U waves, 4 died.[ncbi.nlm.nih.gov]

Etiology

  • Conventional therapy including nitrates, beta blockers, and surgical bypass has proved to be generally unsatisfactory in patients with variant angina of suspected vasospastic etiology.[ncbi.nlm.nih.gov]
  • In six patients neither histamine nor ergonovine provoked spasm, and these patients were considered by chronic follow-up evaluation to have noncardiac etiology for their chest pain syndrome.[ncbi.nlm.nih.gov]
  • Although the etiology and pathogenesis are still unknown, we believe that ECPA (with or without SCAD) might be a distinct new type of coronary arteritis.[ncbi.nlm.nih.gov]
  • However, the etiology of vasospastic angina is ill-defined, making targeted pharmacotherapy difficult. Most patients receive pharmacotherapy that includes calcium channel blockers and/or long-acting nitrates.[ncbi.nlm.nih.gov]
  • This case highlights the mortality associated with prinzmetal angina and the importance of recognizing the underlying etiology. 1.[hindawi.com]

Epidemiology

  • This review describes the epidemiology, pathogenesis, clinical spectrum, and management of variant angina, as well as outcomes in patients who present with aborted sudden cardiac death (ASCD).[ncbi.nlm.nih.gov]
  • The epidemiology of migraine. Am J Med. 2005;118(Suppl 1):S3-S10. 2. Kurth T, Gaziano JM, Cook NR, Logroscino G, Diener HC, Buring JE. Migraine and risk of cardiovascular disease in women. JAMA. 2006;296:283-91. Medline 3.[revespcardiol.org]
  • Epidemiology Vasospastic angina represents about 2.0% of hospital admissions with a clinical pattern of unstable angina. It most frequently appears in the adult age (50 to 60 years) and shows a 5:1 ratio in male:female prevalence.[escardio.org]
  • An epidemiologic review. Headache. 2004 May. 44 Suppl 1:S5-12. [Medline]. Hirano Y, Uehara H, Nakamura H, et al.[emedicine.com]
Sex distribution
Age distribution

Pathophysiology

  • Until the pathophysiology of this syndrome is clarified, however, the associated risks and the results to be expected from surgical therapy are unknown. FULL TEXT[annals.org]
  • Cardiac rehabilitation programs have also been The section on pathophysiology begins with a established to facilitate the return to function of chapter by Greenfield and Rembert discussing patients who have had acute coronary insuffi the factors that[books.google.com]
  • Part I updates the pathophysiology, clinical presentation and prognosis of angina pectoris. Part II aims to put in numbers' the symptoms and signs of myocardial ischemia, starting from a revision of the currently used parameters.[books.google.it]
  • With better understanding of the interactions between inflammation, endothelium, and smooth muscle cells, we and other investigators have provided new insights into the basic pathophysiology of CVsA.[ncbi.nlm.nih.gov]

Prevention

  • Coronary vasospasm may be directly prevented by a general inhibition of smooth muscle contraction by the calcium antagonist.[ncbi.nlm.nih.gov]
  • Levodopa and carbidopa consistently prevented the occurrence of ischemia after hyperventilation in 6 of the 15 patients. This was due to inhibition of local coronary spasm in 2 patients and reduced coronary constriction in 4.[ncbi.nlm.nih.gov]
  • In addition to calcium-blocking agents, amiodarone is another spasmolytic drug which effects smooth muscle relaxation by different mechanisms and appears to be useful for the chronic treatment and prevention of variant angina.[ncbi.nlm.nih.gov]
  • There acute coronary insufficiency, the health care sys are brief sections on prediction and prevention of tem is presented with a challenging diagnostic ischemic events, methods of diagnosing and siz and management problem.[books.google.com]
  • .: Specific inhibitors and promoters of calcium action in the excitation-contraction coupling of heart muscle and their role in the prevention or production of myocardial lesions. In Calcium and the Heart, ed. ‎[books.google.it]

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