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Variant angina with a strong spasmodic trait.

K K Koh, J W Son, E K Shin

International Journal of Cardiology

|February 24, 2001

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A patient experienced severe chest pain at rest, unresponsive to standard medication. Diagnostic tests revealed a complete blockage in a major heart artery, indicating severe coronary artery disease.

Area of Science:

Cardiology
Vascular Medicine
Diagnostic Testing

Background:

Coronary artery disease (CAD) is a leading cause of morbidity and mortality.
Vasospastic angina can present with ischemic symptoms at rest.
Intravenous isosorbide dinitrate is used for managing acute coronary syndromes.

Observation:

A 55-year-old male presented with recurrent early morning chest pain at rest.
Continuous intravenous infusion of isosorbide dinitrate was initiated for symptom management.
An ergonovine provocation test was performed to assess for coronary artery spasm.

Findings:

The ergonovine test identified total occlusion of the mid-left anterior descending artery.
Significant ST-segment elevation was observed during the exercise test, despite ongoing isosorbide dinitrate.

Related Experiment Videos

These findings indicate severe, dynamic coronary artery obstruction.

Implications:

Coronary artery spasm can lead to acute myocardial infarction and sudden cardiac death.
Standard anti-anginal therapy may be insufficient in cases of severe vasospasm.
Early and accurate diagnosis through provocative testing is crucial for guiding treatment strategies.