Vasospastic angina: a review on diagnostic approach and management

Jenkins, Kenny; Pompei, Graziella; Ganzorig, Nandine; Brown, Sarah; Beltrame, John; Kunadian, Vijay

doi:10.1177/17539447241230400

Cited by 7 publications

(1 citation statement)

References 92 publications

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“…Endothelial dysfunction, which impairs the release of vasodilators like nitric oxide, further contributes to the spasm. Genetic factors, in ammation, oxidative stress, and autonomic nervous system imbalances are also thought to play signi cant roles in the pathophysiology of coronary vasospasm (5). Angina attacks are usually short lived (2-5 minute duration) but tends to recur.…”

Section: Discussionmentioning

confidence: 99%

Successful Use of Levosimendan in Managing Refractory Coronary Vasospasm Leading to Recurrent Cardiac Arrests: A Case Report

Ralota,

Wang,

Layland

2024

Preprint

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Background Coronary vasospasm can be life threatening and can be refractory. First line therapies include calcium channel blockers and nitrates; however, they have variable effectiveness. This case report presents a case of refractory coronary artery vasospasm presenting with ST elevation and recurrent cardiac arrest who was treated with levosimendan, a distinctive inodilator with calcium-sensitising and ATP-sensitive potassium channel opening properties, highlighting its potential therapeutic role in this clinical setting. Case Presentation: A 57-year-old male with an established diagnosis of coronary vasospasm presenting with ST elevation in the inferior leads and suffered multiple cardiac arrests, initially treated with electrical defibrillation and advanced life support measures. Angiography showed mild coronary artery disease unchanged from previous angiograms. The patient was managed in the Intensive Care Unit (ICU) with Glyceryl trinitrate (GTN) infusion but continued to have episodes of inferior ST elevations on electrocardiogram (ECG). Given the refractory vasospasm, levosimendan infusion was initiated at 0.2 mcg/kg/min for 24 hours, leading to stabilization with no further episodes and was eventually discharged from hospital. Conclusions Levosimendan, with its unique pharmacological profile as a calcium sensitizer and potassium channel opener, offers a promising therapeutic option for managing refractory coronary vasospasm. Its dual action improves cardiac contractility and induces significant vasodilation, addressing the underlying pathophysiology of vasospasm. The presented case highlights the potential of levosimendan in stabilizing patients with refractory coronary vasospasm when conventional therapies fail. Further research and clinical trials are warranted to establish its efficacy and safety profile in a broader patient population.

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Section: Discussionmentioning

confidence: 99%

Successful Use of Levosimendan in Managing Refractory Coronary Vasospasm Leading to Recurrent Cardiac Arrests: A Case Report

Ralota,

Wang,

Layland

2024

Preprint

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Novel diagnostic approaches and management of coronary microvascular dysfunction

Pompei,

Ganzorig,

Kotanidis

et al. 2024

American Journal of Preventive Cardiology

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Patients With Non-Obstructive Coronary Artery Disease and Polyvascular Disease. Sub-Analysis of the Real-World Registry KAMMA (Clinical Registry on Patient Population With Polyvascular Disease in the Russian Federation and Eurasian Countries)

Arutyunov,

Tarlovskaya,

Arutyunov

et al. 2024

Kardiologiia

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Aim. To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry.Material and methods. The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis <50%, n = 165; 8.7%).Results. A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group.Conclusion. IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the “aggressiveness” of therapy.

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Vasospastic angina: a review on diagnostic approach and management

Cited by 7 publications

References 92 publications

Successful Use of Levosimendan in Managing Refractory Coronary Vasospasm Leading to Recurrent Cardiac Arrests: A Case Report

Successful Use of Levosimendan in Managing Refractory Coronary Vasospasm Leading to Recurrent Cardiac Arrests: A Case Report

Novel diagnostic approaches and management of coronary microvascular dysfunction

Patients With Non-Obstructive Coronary Artery Disease and Polyvascular Disease. Sub-Analysis of the Real-World Registry KAMMA (Clinical Registry on Patient Population With Polyvascular Disease in the Russian Federation and Eurasian Countries)

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