Long lasting spasticity in controlled vasospastic angina

Abstract

Objective-To evaluate changes in coronary artery spasticity in patients with vasospastic angina who had been stable for years under continuous drug treatment. Methods-Follow up coronary angiography was performed under intracoronary ergonovine provocation in 27 well controlled patients with vasospastic angina and no organic stenosis; the tests were done > 24 months after the initial coronary angiography, in which occlusive spasm had been induced by the same regimen of ergonovine provocation. Results-The mean (SD) follow up period was 47.2 (21.6) months. All patients had been free from angina attack for more than 24 months under treatment with antianginal drugs. During this follow up period, organic stenosis developed in only one case. Occlusive spasm was observed during follow up coronary angiography in 23 patients. Spasm with 90% narrowing was observed in three other patients, and diVuse significant narrowing was seen in the final patient. No significant diVerence was found in spasticity (p = 0.75) between the initial and the follow up tests. Conclusions-Repeated ergonovine provocation during coronary angiography after a controlled period of several years showed that coronary spasm remains inducible in most patients. Discontinuance of drug treatment during the remission from anginal attacks achieved by medication may put the patient at high risk. (Heart 1999;81:528-532)

Relationship between Inflammation and Vasospastic Angina

“…Cardioverter defibrillator implantation with adequate pharmacological therapy for CAS was suggested to be an appropriate option for patients who had syncope or ventricular tachycardia or had survived hospital cardiac arrest [ 43 ]. Pharmacological treatment for VSA with calcium antagonists is suggested to be lifelong, not only because of persistent long-term spasticity of the coronary arteries [ 44 ] but also the probability of silent myocardial ischemia. Silent myocardial ischemia caused by any pathologies could be complicated by fatal or nonfatal cardiovascular events, even, as previously mentioned, ventricular arrhythmias and cardiac death.…”

“…Balances within the sympathetic and parasympathetic tone also regulate the coronaries’ flow. Since multiple factors can contribute to the development of VSA, an occurrence of VSA is variable and therefore unpredictable [ 44 ].…”

Coronary Artery Spasm: Review and Update

“…Of note, this score has been suggested to be applied on the premise that CAS patients receive adequate medical treatment 48 . While the actual frequency of CAS attacks is difficult to assess because their occurrences tend to fluctuate, and are not necessarily accompanied by symptoms, treatments for CAS after diagnosis, which may be silent and lethal, should not be discontinued 153 .…”

Treatment of Coronary Spastic Angina, Particularly Medically Refractory Coronary Spasm

“…Nicorandil, which has the vasodilatory effect of both nitroglycerin and potassium channel openers, has been shown to be effective in patients with CSA (18,19). However, there are chances of potential coronary spasm in future (20,21), and therefore, patients should be advised to consult a cardiologist before discontinuing the vasodilators even if they have been symptom-free for a long time. Abrupt cessation of vasodilator therapy sometimes causes severe rebound attacks of angina.…”