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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
Summary
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.