Intracoronary nicorandil relieves multiple coronary vasospasm with hemodynamic collapse

Area of Science:

• Cardiology
• Pharmacology

Background:

• Coronary vasospasm can cause severe chest discomfort and hemodynamic compromise.
• Standard treatments like isosorbide dinitrate and verapamil may not always be effective.

Observation:

• A patient presented with chest discomfort due to subtotal coronary artery occlusion, suspected to be vasospasm.
• Intracoronary isosorbide dinitrate and intravenous verapamil failed to alleviate symptoms.
• Intracoronary nicorandil, a potassium-channel opener, provided significant relief.

Findings:

• Nicorandil demonstrated efficacy in relieving coronary vasospasm refractory to other treatments.
• The patient experienced recurrent symptoms upon medication cessation, which were again resolved by nicorandil.

Implications:

• Nicorandil may be a valuable therapeutic option for managing refractory coronary vasospasm.
• This case underscores the importance of identifying and treating coronary vasospasm effectively to prevent adverse cardiovascular events.