Document Detail


Clandestine ischemia in patients with vasospastic angina.
MedLine Citation:
PMID:  10895404     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Coronary vasospasms generally occur at rest, but can also be triggered by physical exercise. Anginal pain and ST-segment elevation may be seen during exercise-stress tests. ST-segment depression, due to nonocclusive vasospasms, has also been found to occur. When the result of a test is positive, scintigraphy usually reveals perfusion defects. True silent or clandestine ischemia (normal result of exercise test with perfusion defects) in these patients is very uncommon. OBJECTIVE: To stress the need for suspecting occurrence of coronary vasospasms in order to perform a proper diagnosis. METHODS: Eight patients with angina were selected for this study. They had negative results of exercise tests with perfusion defects detected by thallium-201 tomography, normal coronary arteries and vasospasms. Maximal exercise-stress tests with thallium-201 tomography were performed. Sizes of perfusion defects were quantified by examining polar maps. Coronary angiography and then an intracoronary ergonovine test were performed for each patient. RESULTS: Significant defects were seen in territory of the right coronary artery, the left anterior descending artery, or both. Lung:heart ratio was normal in every case. The coronary arteries were normal and vasospasms were elicited with ergonovine in all the patients. Correspondence between the location of perfusion defects and angiographic spasms was generally observed. After treatment with calcium antagonists and nitrates all of them improved and defects detected by thallium tomography were no longer found when tests were repeated. CONCLUSIONS: Some patients with vasospastic angina may have normal results of exercise-stress tests and reversible perfusion defects detectable by scintigraphy. This finding must lead one to perform coronary angiography without administration of nitroglycerine beforehand and an ergonovine test if the coronary arteries are normal.
Authors:
I Coma-Canella; D Martínez-Caro; J Cosín-Sales; E Fernandez-Jarne; M J García Velloso; M Gimenez
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Coronary artery disease     Volume:  11     ISSN:  0954-6928     ISO Abbreviation:  Coron. Artery Dis.     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2000-10-25     Completed Date:  2000-11-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9011445     Medline TA:  Coron Artery Dis     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  383-90     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Facultad de Medicina, Universidad de Navarra, Pamplona, Spain. icoma@unav.es
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angina Pectoris, Variant / complications,  diagnosis*,  physiopathology
Coronary Angiography
Coronary Vessels
Diagnosis, Differential
Electrocardiography
Ergonovine / administration & dosage,  diagnostic use
Exercise Test
Female
Humans
Injections, Intra-Arterial
Male
Middle Aged
Myocardial Ischemia / diagnosis,  etiology,  physiopathology
Oxytocics / administration & dosage,  diagnostic use
Tomography, Emission-Computed, Single-Photon
Chemical
Reg. No./Substance:
0/Oxytocics; 60-79-7/Ergonovine

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