Presentation
Contrary to prior opinions, evidence from recent observational studies indicate that patients with variant angina presenting with ASCD face a worse prognosis than those without this type of presentation. [ncbi.nlm.nih.gov]
Pain, when present, seemed just a concomitant symptom not significantly interfering with the circulatory changes associated with the episodes of this form of angina pectoris. [heart.bmj.com]
Entire Body System
- Coronary Atherosclerosis
Such response could not be predicted by demographic factors, ECG changes, or degree of coronary atherosclerosis. [ncbi.nlm.nih.gov]
[…] revascularization is only useful when the patient shows concomitant coronary atherosclerosis on coronary angiogram. [ipfs.io]
Cardiovascular
- Chest Pain
Another 23 subjects with incompletely explained chest pain given methacholine had neither ECG change nor spasm. [ncbi.nlm.nih.gov]
The goal of treatment is to control chest pain and prevent a heart attack. A medicine called nitroglycerin (NTG) can relieve an episode of pain. Your health care provider may prescribe other medicines to prevent chest pain. [nlm.nih.gov]
During coronary angiography, arterial spasm occurred associated with chest pain and ventricular ectopic beats. This was relieved by the acute administration of sublingual nitrates. [amjmed.com]
- Heart Disease
Some examples of cardiovascular diseases include ischemic heart disease, heart valve disease, cardiomyopathies, peripheral artery disease, congenital heart disease, and vascular disease of the kidneys. This study is located in Bethesda, Maryland. [nhlbi.nih.gov]
Continue reading → Tags: cardiac syndrome X, coronary artery obstruction, coronary microvascular disease, diagnosing heart disease in women, heart attack symptoms, ischemic heart disease, microvascular disease, MVD, non-obstructive heart disease, prinzmetal's [myheartsisters.org]
Signs and Symptoms of Coronary Heart Disease This web page presents an overview of coronary heart disease, explaining angina as the most frequent symptom of coronary heart disease. Medication vs. [pacificmedicaltraining.com]
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]
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]
Musculoskeletal
- Shoulder Pain
Angina may be more difficult to identify in some elderly people when they have symptoms such as abdominal pain after eating (due to increased blood demand for digestion) or have back or shoulder pain (which may be attributed to arthritis). [labtestsonline.org]
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]
Hence, the coronary angiography is usually part of the workup of these patients and can help to guide the treatment4,6. Treatment Nitrates and calcium channel blockers are the main treatments for patients with variant angina. [scielo.br]
X-Ray
- Calcified Aortic Valve
Replacement of the calcified aortic valve resulted in total relief of symptomatology. [ncbi.nlm.nih.gov]
QT, RR, ST Intervals
- 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]
Associated with reversible ST elevations on ECG. Does not cause an increase in serum concentrations of cardiac biomarkers. [youtube.com]
Single channel Holter recording during syncope showing normal ST segment (1) and ST segment elevation (2); during ST segment elevation severe ventricular arrhythmias were detected (transient ventricular tachycardia and fibrillation). [tandfonline.com]
ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall I21.1 ST elevation (STEMI) myocardial infarction of inferior wall I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery I21.19 ST [icd10data.com]
At the onset of this dangerous state an unusual ischemic ST elevation, the "Prinzmetal dome phenomenon," was seen. [annals.org]
Rhythm
- Early Repolarization
The inducibility of polymorphic ventricular tachycardia or ventricular fibrillation, increased QT dispersion, T‐wave alternans, and early repolarization during the asymptomatic period are considered risk markers for ventricular arrhythmias during coronary [doi.org]
The inducibility of polymorphic ventricular tachycardia or ventricular fibrillation, increased QT dispersion, T-wave alternans, and early repolarization during the asymptomatic period are considered risk markers for ventricular arrhythmias during coronary [ncbi.nlm.nih.gov]
Similarly, an early repolarization pattern has been described with a possible negative prognostic impact and a related increased risk of ventricular rhythm disorders; the sudden ischemia generated by the spasm favors the occurrence of both polymorphic [cardiocases.com]
T Wave
- T Wave Inversion
wave inversion or flattening from previous MI Exercise ECG Thallium test Coronary angiography Exclude precipitating factors – anaemia, diabetes, hyperlipidaemia, thyrotoxicosis, GCA Management Change lifestyle Treat modifiable risk factors – hypertension [medicalnotesonline.blogspot.com]
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]
Miwa K, Kambara H, Kawai C, Murakami T. 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]. [emedicine.com]
- T Wave Alternans
The inducibility of polymorphic ventricular tachycardia or ventricular fibrillation, increased QT dispersion, T-wave alternans, and early repolarization during the asymptomatic period are considered risk markers for ventricular arrhythmias during coronary [ncbi.nlm.nih.gov]
The inducibility of polymorphic ventricular tachycardia or ventricular fibrillation, increased QT dispersion, T‐wave alternans, and early repolarization during the asymptomatic period are considered risk markers for ventricular arrhythmias during coronary [doi.org]
Other ECG Findings
- 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]
They also demonstrate the importance of Holter monitoring (of 24–48 h) or loop recorders (depending on the frequency of symptoms) illustrating both ischemic changes and the ventricular arrhythmias caused by this ischemic environment. [tandfonline.com]
ischemic and non-ischemic heart disease. [journalofcardiologycases.com]
The original definition of cardiac syndrome X also mandated that ischemic changes on exercise (despite normal coronary arteries) were displayed, as shown on cardiac stress tests.[9] The primary cause of cardiac syndrome X is unknown, but factors apparently [en.wikipedia.org]
Treatment
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]
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 (VAP) is different to classical atherosclerotic AP in terms of etiology, treatment, and prognosis [ 1 Stern S. Bayes de Luna A. Coronary artery spasm: a 2009 update., ]. [internationaljournalofcardiology.com]
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]
Description : • Angina caused by transient coronary spasms (usually occurring close to areas of coronary stenosis) • Unrelated to exertion and may even occur at rest (classically at night) Etiology : e.g., cigarette smoking, use of stimulants (e.g., cocaine [youtube.com]
This case highlights the mortality associated with prinzmetal angina and the importance of recognizing the underlying etiology. 1. [hindawi.com]
Epidemiology
[…] cigarette smoking, use of stimulants (e.g., cocaine, amphetamines) or sumatriptan, alcohol, stress, hyperventilation, exposure to cold • There is an association with other disorders involving vasospasms (e.g., Raynaud phenomenon, migraine headaches) Epidemiology [youtube.com]
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]
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]
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]
It is now known that variant angina is the result of transient coronary artery spasm at the site of an atherosclerotic plaque.[1] The pathophysiologic effect of coronary spasm is the rapid development of transmural myocardial ischemia resulting in ST-segment [medscape.com]
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]
Prevention
Coronary vasospasm may be directly prevented by a general inhibition of smooth muscle contraction by the calcium antagonist. [ncbi.nlm.nih.gov]
Recent data, on the other hand, suggest that coronary angioplasty with stenting might help to prevent coronary spasm in refractory variant angina9. [escardio.org]
This is helping us to understand, prevent, and manage angina. It also supports research aimed at preventing and treating pediatric and adult cardiovascular diseases. [nhlbi.nih.gov]