Related Experiment Video

Updated: Aug 18, 2026

Acetylcholine Re-Challenge After Intracoronary Nitroglycerine Administration
07:59

Acetylcholine Re-Challenge After Intracoronary Nitroglycerine Administration

Published on: April 4, 2022

[Acute coronary syndrome after diclofenac induced coronary spasm]

A Wieckhorst1, A Tiroke, M Lins

  • 1Universitätsklinikum Schleswig Holstein, Campus Kiel, Med. Klinik, Klinik für Kardiologie, Schittenhelmstrasse 12, 24105 Kiel, Germany. Wieckh.@gmx.de

Zeitschrift Fur Kardiologie
|April 2, 2005
PubMed

Insights

Diclofenac, a nonsteroidal anti-inflammatory drug, can provoke coronary vasospasm, leading to acute myocardial infarction. This case highlights the potential risks of NSAIDs in patients with coronary artery disease.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Acute coronary syndrome (ACS) requires prompt diagnosis and management.
  • Percutaneous coronary intervention (PCI) is a standard treatment for obstructive coronary artery disease.

Observation:

  • A 67-year-old man presented with ACS due to a left anterior descending thrombus, treated with PCI.
  • Post-PCI, the patient developed podagra, treated with colchicine and diclofenac.
  • Following diclofenac administration, the patient experienced severe angina and signs of myocardial infarction.

Findings:

  • Coronary angiography revealed extensive right coronary artery vasospasm.
  • Intracoronary verapamil and nitroglycerin successfully resolved the vasospasm.
  • The patient self-reported diclofenac use prior to symptom onset.

Implications:

  • Oral diclofenac can precipitate coronary vasospasm, even in patients without significant coronary artery disease.
  • Clinicians should exercise caution when prescribing NSAIDs to patients with or at risk for coronary artery disease.
  • This case underscores the importance of a thorough medication history in managing cardiovascular events.

More Related Videos

Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm06:18

Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm

Published on: September 17, 2021

Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders06:39

Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders

Published on: August 18, 2016

Related Concept Videos

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Acute Coronary Syndrome V: Nursing Management01:26

Acute Coronary Syndrome V: Nursing Management

Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
Coronary Artery Disease III: Clinical Manifestations01:30

Coronary Artery Disease III: Clinical Manifestations

Coronary Artery Disease (CAD) is a primary health risk worldwide, leading to significant morbidity and mortality. The condition arises from the buildup of atherosclerotic plaques within the coronary arteries, resulting in diminished blood supply to the heart muscle.The clinical manifestations of CAD vary widely, from asymptomatic stages to severe, life-threatening conditions. Understanding these manifestations is crucial for early diagnosis and effective management.Angina Pectoris: The Warning...