Diagnosis of vasospastic angina: Comparison of hyperventilation and cold-pressor stress echocardiography, hyperventilation and cold-pressor stress coronary angiography, and coronary angiography with intracoronary injection of acetylcholine

Hyperventilation-induced ST segment elevation mimicking acute myocardial infarction in a comatose patient with tracheostomy

“…Respiratory alkalosis by hyperventilation is an effective stimulus for coronary artery spasm, and has been proposed as a part of the diagnostic workup for Prinzmetal's angina [1][2][3][4].…”

“…Hyperventilation and/or cold-pressor test have been proposed as valuable methods for reproducing the spasm, even during stress-echocardiography [1][2][3][4].…”

Transient left ventricular apical ballooning and exercise induced hypertension during treadmill exercise testing: is there a common hypersympathetic mechanism?

“…A marked increase in afterload during exercise due to hypertensive response could precipitate WMA. Another possible mechanism could be transient coronary vasospasm due to hyperventilation during exercise stress test [ 6 ]. But again, this cannot explain specific apical and basal segment akinesis.…”

Noninvasive evaluation of dynamic microvascular dysfunction in ischemia and no obstructive coronary artery disease patients with suspected vasospasm

“…Extended research from the same group of authors further confirmed that severity and even the region of coronary spasm provoked by hyperventilation and cold pressor tests are identical to those induced by intracoronary injection of acetylcholine during CAG. 8 Recently, the large study by Om et al demonstrated the safety and prognostic value of ergonovine echocardiography in the large group of 14 012 patients. The overall frequency of positive results was 15.3% (n ¼ 2144) and most of these patients (99.6%) showed RWMAs.…”

“…Previous studies suggest that HYP is a clinically useful provocative test, as this test has been shown by angiography to induce coronary artery spasm in susceptible patients. 8 The role of transthoracic echocardiography (TTE) with Doppler for assessing coronary flow velocity reserve (CFVR) in the left anterior descending artery (LAD) during provocative tests in patients with chest pain and INOCA was also acknowledged in the new Guidelines of the American College of Cardiology/American Heart Association for Evaluation and Diagnosis of chest pain, receiving recommendation IIb. 9 The aim of our study was to assess the feasibility and potential value of noninvasive assessment of dynamic CMD in INOCA patients in order to identify different endotypes of coronary vasomotor dysfunction in patients with angina and suspected coronary vasospasm.…”