Adenosine-Induced Coronary Artery Spasm: A Case Report

Ismail, Montaser; Asaad, Nidal; Al-Suwaidi, Jassim

doi:10.1159/000331809

Cited by 5 publications

(7 citation statements)

References 22 publications

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“…The coronary arteries in variant angina generally demonstrate organic stenosis, although they may also be angiographically normal. Emotional stress, heavy smoking, drug addiction, and in vivo inflammatory response can lead to coronary artery spasm [ 1 , 2 ]. The release of inflammatory mediators during allergic or hypersensitive and anaphylactic or anaphylactoid insults has been implicated in inducing coronary artery spasm [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcome of Coronary Stenting in Patients with Variant Angina Refractory to Medical Treatment: A Consecutive Single-Center Analysis

Chu

Zhang

et al. 2013

Med Princ Pract

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Objective: To investigate the efficacy of coronary stenting in patients with variant angina refractory to medical treatment. Subjects and Methods: Variant angina was diagnosed in 81 patients admitted to the Department of Cardiology between January 2003 and June 2011. However, coronary stenting was performed in 21 patients refractory to medical treatment, but coronary angiography and intravascular ultrasound were performed in all patients, and acetylcholine provocative test was performed in 11 of the 21 patients refractory to medical treatment. Coronary angiography was repeated after 9-12 months in the 21 patients with coronary stents. Clinical follow-up time was 2.5 ± 3.1 years (range 1-8). Results: Of the 81 patients, coronary angiography and intravascular ultrasound did not reveal significant stenosis in 13 (16.0%), but revealed 20-75% fixed stenosis in the remaining 68 (84.0%) patients. The acetylcholine provocative test was positive in the 11 patients. Of the 21 patients with coronary stents, the spasm site was located in the right coronary artery in 16 (76.2%) and in the left anterior descending artery in the remaining 5 (23.8%) patients. During the 1- to 8-year follow-up period, 1 of the 21 patients with stents developed recurrent episodes of variant angina, 5 patients had occasional chest pain, and the other 15 were asymptomatic. Coronary angiography at 9-12 months after initial evaluation demonstrated no stenosis in 3 patients, 20-40% in-stent mild intimal hyperplasia in 15 patients, and 50-80% in-stent restenosis in 3 patients. Coronary stenting was performed again in 2 patients. Conclusions: The present study showed that coronary stenting for severe refractory coronary vasospasm was effective and without serious complications. It can be an alternative and viable option for some patients who are refractory to medical therapy and at a high risk of acute coronary syndrome recurrence.

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Section: Introductionmentioning

confidence: 99%

Clinical Outcome of Coronary Stenting in Patients with Variant Angina Refractory to Medical Treatment: A Consecutive Single-Center Analysis

Chu

Zhang

et al. 2013

Med Princ Pract

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“…A number of cases of coronary vasospasm during [3, 4] or after [4–6] an adenosine stress test have been reported; however adenosine induced coronary artery vasospasm provoked by intravenous administration for SVT termination has only recently been reported [7], and our patient would constitute the second reported case worldwide. Coronary artery spasm results from the interaction of 2 components: (1) usually localized, but sometimes diffuse, abnormality of a coronary artery that makes it hyperreactive to vasoconstrictor stimuli and (2) a vasoconstrictor stimulus able to induce the spasm at the level of the hyperreactive coronary segment [8].…”

Section: Discussionmentioning

confidence: 97%

Coronary Vasospasm While Treating Supraventricular Tachycardia: Is Adenosine Really to Blame?

Quevedo

Munoz-Mendoza

Miranda

et al. 2013

Case Reports in Cardiology

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Coronary artery spasm has been reported during adenosine stress testing. Herein, we describe a transient ST-segment elevation following adenosine therapy for supraventricular tachycardia. A 38-year-old male presented to the emergency department with palpitations. Electrocardiogram showed supraventricular tachycardia with short RP interval. Vagal maneuvers were unsuccessful. Adenosine was then administered in two successive injections of 6 and 12 mg dosages, respectively. A subsequent 12-lead electrocardiogram revealed ST-segment elevation in inferior leads with reciprocal changes. Coronary angiography disclosed nonobstructive coronary disease. A postprocedure electrocardiogram exhibited normal sinus rhythm with nonspecific T wave abnormalities. Cardiac biomarkers were elevated with a peak troponin I of 0.32. Echocardiogram depicted bicuspid aortic valve and normal systolic function. Electrophysiological study revealed a concealed left accessory pathway and successful radiofrequency ablation was performed. Given the dynamic changes in the electrocardiogram, we hypothesize that this event was most likely a coronary vasospasm. The mechanism of coronary spasm following adenosine injection remains uncertain. Potential mediators include KATP channels and adenosine-2 receptors.

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“…Most of side effects reported with adenosine injection such as flushing, headache, nausea, chest discomfort, shortness of breath are benign, mild and transient in nature 2 . Coronary spasm following injection of adenosine is rare but not an unknown entity 6 . Since the patient developed ST elevation after injection of adenosine which reverted to normal within a few minutes, cause and effect relationship seems highly likely.…”

Section: Discussionmentioning

confidence: 99%

“…Coronary vasospasm due to adenosine is rare, but has been reported most often during stress MPI 4, 5. Rare case reports following administration for treatment of SVT have now started appearing 6 …”

Section: Discussionmentioning

confidence: 99%

“…Coronary vasospasm leading to ST elevation during MPI has been reported rarely4, 5 which resolved spontaneously on discontinuation of infusion. Isolated case reports of transient ST elevation following adenosine injection, given for treatment of SVT are there, 6 but to our knowledge no cases have been reported from the Indian subcontinent.…”

Section: Introductionmentioning

confidence: 96%

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Adenosine induced coronary spasm – A rare presentation

Arora

Bhatia

Arora

et al. 2014

Indian Heart Journal

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Adenosine is commonly used as a pharmacological agent in myocardial perfusion imaging, as an antiarrhythmic agent, and in Cath Lab. during PCI for treating no reflow phenomenon. Coronary spasm has been reported following adenosine injection during stress imaging. We report a rare complication with ST segment elevation, following adenosine injection, given for treatment of supraventricular tachycardia.

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Adenosine-Induced Coronary Artery Spasm: A Case Report

Cited by 5 publications

References 22 publications

Clinical Outcome of Coronary Stenting in Patients with Variant Angina Refractory to Medical Treatment: A Consecutive Single-Center Analysis

Clinical Outcome of Coronary Stenting in Patients with Variant Angina Refractory to Medical Treatment: A Consecutive Single-Center Analysis

Coronary Vasospasm While Treating Supraventricular Tachycardia: Is Adenosine Really to Blame?

Adenosine induced coronary spasm – A rare presentation

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