Usefulness of Massive Oral Nicorandil in a Patient with Variant Angina Refractory to Conventional Treatment.

Kurisu, Satoshi; Inoue, Ichiro; Kawagoe, Takuji; Ishihara, Masaharu; Sakai, Yuji; Nishioka, Kenji; Nakamura, Shuji; Umemura, Takashi; Yoshida, Masashi

doi:10.2169/internalmedicine.42.163

Cited by 12 publications

(10 citation statements)

References 21 publications

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“…Therefore, therapeutic modalities in patients with poor response to conventional medical treatment are still under discussion. Some cases showed the effectiveness of massive oral nicorandil [2], corticosteroids [3], low dose denopamine [4], vitamins C and E [5], or prazosin [6] as a treatment of refractory variant angina. Others reported successful cases of brachytherapy [7] and coronary stenting [1] even if there are still controversies.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of intravenous administration of nicorandil in a patient with variant angina refractory to continuous intravenous nitroglycerin

Lee

Kim

Lim

et al. 2007

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Effectiveness of intravenous administration of nicorandil in a patient with variant angina refractory to continuous intravenous nitroglycerin

Lee

Kim

Lim

et al. 2007

International Journal of Cardiology

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“…11 Not all patients settle with medical treatment. There is a group of patients who respond poorly to pharmacotherapy.…”

Section: Discussionmentioning

confidence: 99%

Failure of intravascular ultrasound to identify the site of recurrent focal coronary spasm during stenting

Azeem

Adlam²,

Gershlick³

2004

Heart

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Focal coronary spasm is often associated with an area of mural plaque disease. This report describes a patient with recurrent severe coronary spasm unresponsive to medical treatment. Coronary arteriography and intravascular ultrasound identified a candidate area of minor coronary atheromatous disease but ergonovine provocation testing showed the spastic coronary segment to be distal to and distinct from this area. Coronary stenting of the site identified by ergonovine provocation testing was effective in relieving provoked and spontaneous spasm. P atients with severe recurrent coronary spasm unresponsive to medical treatment may respond to stenting of the spastic coronary segment. [1][2][3][4] The site of spasm is often associated with an area of mural atheromatous plaque. 5Intravascular ultrasound (IVUS) may be used to identify the site of non-stenotic mural plaque, but spasm provocation testing is necessary to identify the spastic coronary segment for stent deployment. CASE REPORTA 54 year old woman presented to the outpatient clinic of a district general hospital with a five week history of chest pain unrelated to exertion. The pain was central and radiated to the left arm. Symptoms usually occurred in the early hours of the morning, lasting for one or two hours with spontaneous relief. The frequency of chest pain had progressed from two episodes a week to daily. She had a medical history of asthma and controlled hypertension for which she was prescribed salbutamol and fludrocortisone inhalers and enalapril 20 mg once daily. She had recently undergone endoscopy to investigate symptoms of dysphagia, with normal results.Clinical examination in the outpatient clinic was normal. Twelve lead ECG showed symmetrical T wave inversion in chest leads V2-V4 (fig 1). An exercise tolerance test was carried out in the clinic. The patient exercised for over nine minutes with no chest pain. There was pseudonormalisation of the inverted T waves on exercise but no other new ECG changes. Transthoracic echocardiography was normal. The patient was started on clopidogrel 75 mg, long acting diltiazem 200 mg, simvastatin 20 mg, and a glycerine trinitrate spray. She was referred for early outpatient coronary angiography.Eighteen days later she presented to the emergency room after an episode of more severe chest pain. The ECG showed no new changes. Troponin T was 0.2 ng/ml (laboratory range , 1.10) and myoglobin was 63 ng/ml (laboratory range , 70). Inpatient stress echocardiography showed no wall motion abnormality at dobutamine doses up to 40 mg/kg/min. In view of this finding it was felt that there was a low probability of fixed stenotic coronary artery disease. The patient was started on a proton pump inhibitor and discharged. One month later she presented again with severe chest pain. This time a 12 lead ECG undertaken by her primary care physician showed anterior ST segment elevation. This had settled by the time she was admitted to hospital. She was started on intravenous nitrate and unfractionated heparin. Despite this she ha...

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“…Amiodarone [161], ketanserin [165], prazosin [166,167], denopamine (adrenergic beta-1 agonist) [168], angiotensin converting enzyme inhibitors [169] and nicorandil [170,171] have been tested with variable clinical response. They have been proposed either as monotherapy or as an adjunct to calcium antagonists.…”

Section: Othersmentioning

confidence: 99%

Variations in presentation and various options in management of variant angina

Mishra

2006

European Journal of Cardio-Thoracic Surgery

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Patients with variant angina represent a diagnostic and therapeutic dilemma. Variant angina is a disease with various causes, variations in treatment guidelines and variable prognosis. In an era of robotic cardiac surgery and automatic cardioverter defibrillators, it is regrettable that we lack enough information on the optimal management of this entity. Lack of randomised trials and a tendency for spontaneous remissions makes interpretation of results difficult. We review the pathophysiology, presentation and recent developments in medical and surgical management of variant angina. Literature is full of conflicting data and it is difficult to make specific recommendations.

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Usefulness of Massive Oral Nicorandil in a Patient with Variant Angina Refractory to Conventional Treatment.

Cited by 12 publications

References 21 publications

Effectiveness of intravenous administration of nicorandil in a patient with variant angina refractory to continuous intravenous nitroglycerin

Effectiveness of intravenous administration of nicorandil in a patient with variant angina refractory to continuous intravenous nitroglycerin

Failure of intravascular ultrasound to identify the site of recurrent focal coronary spasm during stenting

Variations in presentation and various options in management of variant angina

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