A Missed Case of Vasospastic Angina, Clinched by a Personal Handheld ECG Device.
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ABSTRACT:
SUBMITTER: Sung M
PROVIDER: S-EPMC10366497 | biostudies-literature | 2023 Jul
REPOSITORIES: biostudies-literature
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A Missed Case of Vasospastic Angina, Clinched by a Personal Handheld ECG Device.
Sung Michelle M Chau Edward E Applegate Patricia M PM Atreja Surabhi M SM
JACC. Case reports 20230525
We describe a case of vasospastic angina diagnosed via a personal electrocardiography monitoring device in a middle-aged woman who initially presented with chest pain and angiographic findings demonstrating coronary emboli. (<b>Level of Difficulty: Beginner.</b>). ...[more]
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Project description:We herein report a case of a 56-year-old woman with angina pectoris. She visited our emergency room because of chest pain. She finally underwent emergency percutaneous coronary intervention in right coronary artery due to acute coronary syndrome. Several months later, she complained of exertional chest pain again. Exercise-stress electrocardiogram showed ST-segment depression in V2-V6. However, coronary angiography showed no organic stenosis and we conducted acetylcholine provocation test. We finally detected severe coronary artery spasm and diagnosed exercise-induced vasospastic angina (VSA). This case highlights the importance of the recognition of exercise-induced VSA. Exercise-induced VSA needs the definite diagnosis and appropriate treatment. Learning objective Many patients felt chest pain even if they have undergone percutaneous coronary intervention (PCI). This case highlights the importance of the recognition of exercise-induced vasospastic angina (VSA). Exercise-induced VSA needs definite diagnosis and appropriate treatment. This case report describes the importance of precise diagnosis and highlights the recognition of exercise-induced VSA. We recommend the acetylcholine provocation test after PCI in order to determine the diagnosis of exercise-induced VSA.
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Project description:BackgroundCoronary vascular dysfunction comprises VSA and/or MVA and is more common in women than in men with angina without obstructive coronary artery disease (ANOCA). Invasive coronary function testing is considered the reference test for diagnosis, but its burden on patients is large. We aimed to investigate the potential of electrocardiography (ECG) as noninvasive marker for vasospastic angina (VSA) and microvascular angina (MVA) diagnosis.MethodsWe systematically screened Pubmed and EMBASE databases for studies reporting on ECG characteristics in ANOCA patients with (a suspicion of) coronary vascular dysfunction. We assessed study quality using QUADAS-2. We extracted data on diagnostic values of different ECG characteristics and analyzed whether the studies were sex-stratified.ResultsThirty publications met our criteria, 13 reported on VSA and 17 on MVA. The majority addressed repolarization-related ECG parameters. Only 1 of the 13 VSA papers and 4 of the 17 MVA papers showed diagnostic accuracy measures of the ECG characteristics. The presence of early repolarization, T-wave alternans, and inverted U waves showed of predictive value for VSA diagnosis. The QTc interval was predictive for MVA diagnosis in all six studies reporting on QTc interval. Sex-stratified results were reported in only 5 of the 30 studies and 3 of those observed sex-based differences.ConclusionsECG features are not widely evaluated in diagnostic studies for VSA and MVA. Those features predictive for VSA and MVA diagnosis mostly point to repolarization abnormalities and may contribute to noninvasive risk stratification.
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Project description:BackgroundVasospastic angina usually presents with intermittent episodes of chest pain. It can rarely be associated with the perception of phantom odors.Case summaryA 69-year-old woman presented for evaluation of intermittent shortness of breath and chest pain. She reported that she often experienced an abnormal smell sensation just prior to the event. The patient had abnormal smell sensation and shortness of breath at the initiation of exercise stress echocardiography with transient electrocardiographic changes and new regional wall motion abnormalities. Subsequent invasive coronary angiography showed no obstructive epicardial coronary artery disease. The patient was started on calcium channel blocker therapy with resolution of symptoms.ConclusionPhantom odor perception has been rarely reported as an angina-equivalent symptom. Clinicians should have a high index of suspicion in patients presenting with atypical anginal symptoms.
| S-EPMC11254699 | biostudies-literature
Project description:BackgroundExercise-induced vasospastic angina (VSA) is a relatively uncommon clinical scenario but may be fatal if not appropriately managed.Case summaryA 56-year-old male patient presented to our hospital for chest oppression on exertion for a 2-week duration. The symptom arose while he was riding a bicycle in the morning but did not arise at rest or on exertion in the afternoon. He was an ex-smoker with a history of hypertension and a family history of sudden death. A resting electrocardiogram (ECG) was normal, and echocardiogram revealed no wall motion abnormalities. Coronary computed tomography angiography indicated a possible stenotic lesion in the circumflex branch. Thus, hospitalization was arranged, and transcatheter coronary angiography (CAG) was performed. In CAG, there was only mild stenosis with small perfusion area in the obtuse marginal branch. A treadmill exercise test was performed the following day to assess the contribution of cardiac ischaemia to his chest symptom on exertion. At 10 metabolic equivalents, he suddenly developed chest pain and prominent ST elevation in leads II, III, aVF, and V2-5 was noted on ECG. The test was immediately terminated, and nitrates were administered. The symptom disappeared, and the patient's ECG normalized, confirming the diagnosis of exercise-induced VSA. Another treadmill exercise test was performed 6 days after vasodilators were started. Even at maximum exercise intensity, neither chest symptoms nor ischaemic changes occurred. The patient was discharged, and the chest symptoms have not returned.DiscussionThis case highlights the importance of appropriate diagnosis and management of exercise-induced VSA.
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Project description:A 49-year-old woman affected by fibromuscular dysplasia (FMD) of the carotid artery with recurrent coronary vasospasm, refractory to medical therapy was admitted for anginal pain. Coronary involvement related to FMD is uncommon and its diagnosis "in vivo" still represents a challenge. Although a clear association between FMD and spontaneous coronary artery dissections is described, the presentation as severe coronary vasospasm is rare and it is associated with unfavorable outcome, especially when treated by means of percutaneous coronary intervention. The use of intravascular ultrasound played a key role in choosing the appropriate strategy for the management of the patient. <Learning objective: During the past years fibromuscular dysplasia (FMD) has been recognized as an underdiagnosed underlying pathology possibly associated with acute coronary syndromes, especially in the setting of young women. Coronary involvement has been recently associated with vasospasm, reported in previous cases as severe refractory vasospasm. Intravascular imaging techniques are able to detect FMD structural coronary abnormalities, aiming for clinicians to choose the appropriate strategy for the management of the patient.>.
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Project description:IntroductionPatients with cancer have an increased risk of cardiovascular disease including ischemic heart disease and vice versa. Anticancer drugs and radiotherapy are known to contribute to endothelial injury and vasospasm. However, the relations between vasospastic angina (VSA) and cancer or its treatment are poorly investigated.MethodsA total of 786 patients underwent intracoronary acetylcholine (ACh) provocation tests to diagnose VSA. The positive ACh provocation test was defined as angiographic coronary artery spasm accompanied by chest pain and/or ischemic electrocardiographic changes. Patients were divided into active cancer, a history of cancer, and no cancer according to the status of malignancy. The impact of types of cancer, anticancer drugs, and radiotherapy on VSA was evaluated.ResultsOf 786 patients, 38 (4.8%) and 84 (10.7%) had active cancer and a history of cancer, respectively, and 401 (51.0%) were diagnosed as VSA. There was no significant difference in rates of positive ACh test among patients with active cancer, a history of cancer, and no cancer (39.5% vs. 57.1% vs. 50.9%, p = 0.20). Types of cancer and cancer treatment also had no impact on positive ACh provocation test.ConclusionsIn this cross-sectional observational study, we did not find an association of active and a history of cancer with the diagnosis of VSA. Anticancer treatment including chemotherapy and radiotherapy was not significantly associated with positive ACh provocation test.
| S-EPMC8342335 | biostudies-literature
Project description:BackgroundQTc prolongation is an adverse effect of COVID-19 therapies. The use of a handheld device in this scenario has not been addressed.ObjectivesTo evaluate the feasibility of QTc monitoring with a smart device in COVID-19 patients receiving QTc-interfering therapies.MethodsProspective study of consecutive COVID-19 patients treated with hydroxychloroquine ± azithromycin ± lopinavir-ritonavir. ECG monitoring was performed with 12-lead ECG or with KardiaMobile-6L. Both registries were also sequentially obtained in a cohort of healthy patients. We evaluated differences in QTc in COVID-19 patients between three different monitoring strategies: 12-lead ECG at baseline and follow-up (A), 12-lead ECG at baseline and follow-up with the smart device (B), and fully monitored with handheld 6-lead ECG (group C). Time needed to obtain an ECG registry was also documented.ResultsOne hundred and eighty-two COVID-19 patients were included (A: 119(65.4%); B: 50(27.5%); C: 13(7.1%). QTc peak during hospitalization did significantly increase in all groups. No differences were observed between the three monitoring strategies in QTc prolongation (p = 0.864). In the control group, all but one ECG registry with the smart device allowed QTc measurement and mean QTc did not differ between both techniques (p = 0.612), displaying a moderate reliability (ICC 0.56 [0.19-0.76]). Time of ECG registry was significantly longer for the 12-lead ECG than for handheld device in both cohorts (p < 0.001).ConclusionQTc monitoring with KardiaMobile-6L in COVID-19 patients was feasible. Time of ECG registration was significantly lower with the smart device, which may offer an important advantage for prevention of virus dissemination among healthcare providers.
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Project description:BackgroundFabry disease (FD) is an X-linked lysosomal storage disorder resulting from a deficiency in alpha-galactosidase A. The major causes of death due to cardiac complications include life-threatening arrhythmias. In addition, life-threatening arrhythmias may be related to myocardial fibrosis assessed by late gadolinium enhancement (LGE).Case summaryA 43-year-old man with sinus bradycardia and left ventricular hypertrophy was referred to our cardiology department. Family history includes unexplained hypertrophy and sick sinus syndrome in mother. Additionally, his plasma alpha-galactosidase A activity was low. He was subsequently diagnosed with FD. Enzyme replacement therapy using 1.0 mg/kg agalsidase-β was initiated. During the fifth administration, he developed ventricular fibrillation (VF). Electrocardiography conducted immediately before VF revealed ST elevation in the inferior leads with reciprocated ST depression. Cardiac magnetic resonance imaging showed no LGE in the myocardium. Coronary angiography showed no organic stenosis; moreover, coronary spasms were induced by an intracoronary acetylcholine injection. Ventricular fibrillation was not observed as the patient received calcium antagonists.DiscussionThis report suggests that vasospastic angina pectoris is associated with life-threatening arrhythmias in patient with FD without LGE.
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Project description:Prinzmetal variant angina or vasospastic angina is a clinical syndrome characterised by episodic chest pain and transient reversible ST segment changes in ECG. The aetiology and treatment of the condition are quite different compared to those of conventional coronary artery disease. The crux of the problem in variant angina patients remains the diagnosis, especially if coexisting coronary artery disease is present. Timely diagnosis not only helps relieve symptoms, it also prevents complications such as ventricular tachycardia. Conventional provocative tests are used for diagnosis of such conditions; they have varied sensitively and specificity, and are cumbersome to perform. We present a case of an elderly man who presented with recurrent episodes of breathlessness and chest pain, where Holter monitoring proved to be a better mode for diagnosing variant angina than more invasive provocative tests. In this report, we reemphasis the role of this simple non-invasive diagnostic mode for diagnosis of variant angina.
| S-EPMC4550882 | biostudies-other