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Stress long-axis function in coronary artery spasm

F J Cooke1, J Clague, M Y Henein

  • 1Royal Brompton Hospital, London, U.K.

Clinical Cardiology
|November 11, 1999
PubMed

Insights

This study identifies coronary artery spasm as the cause of angina in a patient with prior myocardial infarction, despite normal initial tests. Ergonovine testing confirmed the spasm, revealing a treatable cause of ischemic symptoms.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Clinical Medicine

Background:

  • Myocardial infarction (MI) survivors often experience recurrent angina.
  • Standard diagnostic tests like coronary angiography, ECG exercise testing, and thallium scans can sometimes fail to identify the cause of ischemia.

Observation:

  • A patient with a history of MI presented with frequent angina.
  • Initial coronary arteriograms, ECG exercise testing, and thallium scans were unremarkable for ischemia.
  • Resting echocardiography revealed increased echo intensity in the distal septum and right ventricular apex.
  • Dobutamine stress echocardiography showed abnormalities in the right ventricle and posteroseptal segments suggestive of ischemia.

Findings:

  • Repeat coronary angiography, provoked by ergonovine administration, confirmed distal right coronary artery spasm.
  • The findings indicate that coronary artery spasm was the underlying cause of the patient's angina.

Implications:

  • Coronary artery spasm should be considered in the differential diagnosis of angina, even with initially normal coronary angiograms.
  • Pharmacological stress testing and provocative angiography are valuable tools for diagnosing coronary artery spasm.
  • Accurate diagnosis of coronary artery spasm can lead to targeted and effective treatment, improving patient outcomes.

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