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Multivessel variant angina unresponsive to urapidil

Tom Vydt1, Antoon Wildiers, Christiaan J Vrints

  • 1Department of Internal medicine, AZ H. Hart, Lier, Belgium.

Acta Cardiologica
|September 17, 2004
PubMed

Insights

Variant angina, a serious heart condition, can lead to sudden cardiac death. This case highlights how coronary artery vasospasm can worsen despite medication, causing severe ischemia.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Critical Care Medicine

Background:

  • Variant angina (Prinzmetal's angina) is characterized by transient coronary artery vasospasm.
  • Recurrent sudden cardiac death is a severe complication associated with coronary vasospastic disorders.

Observation:

  • A patient presented with variant angina and recurrent sudden cardiac death.
  • Coronary angiography revealed diffuse 3-vessel vasoconstriction, worsening in the mid left anterior descending (LAD) artery.
  • Intracoronary urapidil failed to alleviate LAD vasoconstriction.

Findings:

  • Urapidil administration paradoxically induced occlusive vasospasm in the LAD.
  • This occlusive vasospasm was associated with marked myocardial ischemia.
  • The case demonstrates a refractory response to vasodilator therapy in severe variant angina.

Implications:

  • This case underscores the potential for paradoxical worsening of vasospasm with certain vasodilators.
  • It highlights the challenges in managing variant angina complicated by sudden cardiac death.
  • Further research into optimal management strategies for refractory coronary vasospasm is warranted.

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