Conformational Change in Coronary Artery Structure Assessed by Optical Coherence Tomography in Patients With Vasospastic Angina

Tanaka, Atsushi; Shimada, Kenei; Tearney, Guillermo J.; Kitabata, Hironori; Taguchi, Haruyuki; Fukuda, Shota; Kashiwagi, Manabu; Kubo, Takashi; Takarada, Shigeho; Hirata, Kumiko; Mizukoshi, Masato; Yoshikawa, Junichi; Bouma, Brett E.

doi:10.1016/j.jacc.2011.06.046

Cited by 82 publications

(52 citation statements)

References 19 publications

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“…15,16 Moreover, intracoronary imaging by optical coherence tomography has greater resolution and may provide further insight into the characteristics of vasospastic segments, such as increased basal smooth muscle tone in the media. 17 Studies using Holter monitoring or exercise testing have described a diurnal pattern with many episodes of coronary artery vasospasm occurring in the early morning, as in our patient's case. 18,19 Although not necessary in this case, provocative testing using intravenous or intracoronary injection of methylergonovine or ergonovine or intracoronary injection of acetylcholine can be useful in diagnosing coronary artery vasospasm in the patients with normal-appearing coronary arteries on angiography but a clinical presentation concerning for vasospasm; such provocative testing holds a class IIB recommendation from the American Heart Association/American College of Cardiology and a class IIA recommendation by the European Society of Cardiology for this indication.…”

Section: February 23 2016supporting

confidence: 55%

A Shocking Development in a Young Male Athlete With Chest Pain

et al. 2016

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Foreword Information about a real patient is presented in stages (boldface type) to an expert clinician (Dr Deepak L. Bhatt), who responds to the information, sharing his reasoning with the reader (regular type). A discussion by the authors follows. P atient presentation:A 32-year-old male endurance athlete with no significant past history was admitted after experiencing multiple episodes of chest tightness while training for a triathlon. Occasionally, when running up hills, he noted substernal chest pressure that radiated to his left arm and was associated with severe shortness of breath. His past medical history includes seasonal allergic rhinitis and childhood asthma. He takes cetirizine/pseudoephedrine occasionally, but has not taken it recently, and denies taking any other medication or over-the-counter supplement. He admits to occasional binge drinking of 6 to 10 beers once or twice a month. He quit smoking 2 years ago but previously smoked a pack a week for 5 years. He also endorsed a remote history of cocaine use and recent marijuana and energy drink (1-2 small cans; 80 mg of caffeine per 8.4-oz can) use. His family history is only notable for a maternal grandmother who had a myocardial infarction in her 60s and a sister diagnosed with an atrial tachycardia. There is no history of premature coronary artery disease, heart failure, or sudden death. His biological parents and brother are alive and well.Dr Bhatt: At this point, the differential diagnosis for chest pain in a young, otherwise healthy patient is broad. Certainly, the exertional component of his symptoms is concerning and raises the possibility of premature coronary artery disease, although the family history obtained does not suggest a strong predisposition for atherosclerosis. Coronary artery vasospasm would be another possibility, and he has several potential triggers, including alcohol, pseudoephedrine, caffeine, and marijuana use. Vasospasm can occur with exertion, even though we often think of it as occurring at rest. Forms of structural heart disease, such as hypertrophic or infiltrative cardiomyopathy or an anomalous coronary artery, should be entertained. I would also consider an arrhythmia, either supraventricular or ventricular. The appropriate next steps are a targeted physical examination, an ECG, and a transthoracic echocardiogram to evaluate for structural heart disease. Patient presentation (continued):His vital signs were as follows: temperature, 96.0°F; blood pressure, 136/88 mm Hg; heart rate, 56 beats per minute and regular; respiratory rate, 14 breaths per minute; and oxygen saturation, 98% on room air. He was well appearing. His jugular venous pressure was 6 cm H 2 O. His lungs were clear to auscultation bilaterally. His cardiac examination revealed normal S1 and S2 heart sounds, no murmurs or gallops, no heaves, and a nondisplaced apical impulse. His extremities were warm and without edema. Serial troponin-T concentrations were undetectable. An ECG showed normal sinus rhythm with normal intervals and no evidence of hypertr...

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Section: February 23 2016supporting

confidence: 55%

A Shocking Development in a Young Male Athlete With Chest Pain

et al. 2016

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“…optyczna koherentna tomografia) mogą się niekiedy okazać przydatne w identyfikacji zmian odpowiedzialnych za niedokrwienie lub patologii leżą-cych u ich podstaw, tj. pogrubienie warstwy środkowej tętnicy spowodowane jej nieprawidłowym obkurczeniem w skurczu tętnicy wieńcowej lub powierzchowne nadżerki w obrębie pokrywy włóknistej w zmianie miażdżycowej niepowodującej istotnego zwężenia [318][319][320].…”

Section: Identyfikacja Zmiany Odpowiedzialnej Za Niedokrwienieunclassified

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Roffi¹,

Patrono²,

Collet³

et al. 2015

Kardiol Pol

210

165

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“…These reports indicated that intracoronary erosion and thrombus formation may occur within spastic segments. Using OCT, Tanaka et al [8] demonstrated initial gathering, characterized by folding or gathering of the intima, at spastic segments during spasm. Therefore, coronary spasms may lead to hypercontraction and extension of the intima, which results in coronary erosion formation.…”

Section: Discussionmentioning

confidence: 99%

A Case of Vasospastic Angina Involving Erosion and Thrombus within the Spastic Segment Detected by Coronary Angioscopy

Kido¹,

Fujii²,

Oshita³

et al. 2017

Angiol

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A-58-year-old female who had been treated for vasospastic angina had difficulty in breathing and palpitations during rest at night. She was admitted to our institution for a detailed examination of her symptoms. Coronary angiography showed no obvious coronary stenosis. Thereafter, we performed the spasm provocation test (SPT), firstly in the right coronary artery (RCA) and then in the left coronary artery (LCA), using intracoronary infusions of acetylcholine. SPT revealed a focal spasm at the distal segment of RCA and diffuse spasms at the left anterior descending coronary artery (LAD) and left circumflex artery. An intracoronary infusion of nitroglycerin relieved coronary spasms. Coronary angioscopy revealed erosions and white thrombus at the spastic segment of the proximal segment of LAD. Administration of two types of coronary vasodilators improved chest symptoms. Recent studies have focused on acute coronary syndrome without plaque rupture, and coronary spasm has been proposed as one of the underlying mechanisms responsible. The findings of the present case may support a relationship between coronary spasm and coronary erosion with thrombus formation.

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Conformational Change in Coronary Artery Structure Assessed by Optical Coherence Tomography in Patients With Vasospastic Angina

Cited by 82 publications

References 19 publications

A Shocking Development in a Young Male Athlete With Chest Pain

A Shocking Development in a Young Male Athlete With Chest Pain

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

A Case of Vasospastic Angina Involving Erosion and Thrombus within the Spastic Segment Detected by Coronary Angioscopy

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