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A Case of Variant Angina with Positive Angiography

Wei Zhang1, Xueying Pan1, Weiting Xu1, Wenqian Wei2 and Xiang Zhou1*
1Department of Cardiology, The Second Affiliated Hospital of Soochow University, China
2Department of Cardiology, The Second Clinical Medical College of Soochow University, China


*Corresponding author: Xiang Zhou, Department of Cardiology, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou, Jiangsu 215004, China


Published: 31 Oct, 2016
Cite this article as: Zhang W, Pan X, Xu W, Wei W, Zhou X. A Case of Variant Angina with Positive Angiography. J Heart Stroke. 2016; 1(1): 1005.

Clinical Image

The patient, male, 52 years old, was admitted to hospital for sudden chest pain. He has hypertension and smoking histories for more than 10 years. In the Emergency Department, the electrocardiogram showed ST-segment elevation on the II, III, AVF leads and second degree atrioventricular block (Figure 1). The troponin T and other biochemical indexes were normal. Emergent coronary angiography was performed immediately, and we found an approximately 90% stenosis in the middle segment of right coronary artery (Figure 2). Nitroglycerin was then intracoronarily administered to determine the nature of stenosis, to our surprise, the stenosis was significantly relieved (Figure 3), and the elevated ST segments restored to normal (Figure 4). We finally recognized that the stenosis was caused by coronary artery spasm, also called variant angina.
Variant angina is secondary to reversible coronary artery vasospasm in the context of both diseased and non-diseased coronary arteries. Symptoms typically occur when the patient is at rest, especially in the early morning, it can be triggered by emotional stress, smoking, or cold weather. The electrocardiogram often shows a transient ST-segment elevation. Although the exact etiology of coronary vasospasm remains unclear, several mechanisms have been hypothesised. A combination of arterial wall dysfunction and vasoactive substances are thought to be involved. Current treatment involves the use of calcium channel blockers, nitrates and betablockers. Long-acting calcium channel blockers have been shown to decrease the number of anginal attacks and are considered the mainstay of treatment. In addition to medical treatment, smoking cessation is associated with a reduction in symptoms.
In this case, based on the typical chest pain and electrocardiogram changes, we diagnosed as acute inferior myocardial infarction and carried out coronary angiography immediately. We found a significant stenosis in the middle segment of right coronary artery and planned to implant a stent. However, when the nitroglycerin was intracoronarily injected, the stenosis was relieved. Therefore, injection of nitroglycerin might be an indispensable step before stent ing for interventional physicians.


Figure 1

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Figure 1
Electrocardiogram on admission.

Figure 2

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Figure 2
Right coronary angiography.

Figure 3

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Figure 3
Right coronary angiography after nitroglycerin injection.

Figure 4

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Figure 4
Electrocardiogram after chest pain relief.