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A case of variant angina developing transient collateral circulation during vasospasm.
Won Seop Lee1, Dae Hyeok Kim, Keum Soo Park
1Division of Cardiology, Cardiac and Vascular Center, Inha University College of Medicine, Incheon, Korea.
Korean Circulation Journal
|May 25, 2011
Summary
Variant angina typically shows ST elevation, but this case demonstrated vasospasm and chest pain without it. Transient collateral circulation during vasospasm is a key consideration in such atypical variant angina cases.
Area of Science:
- Cardiology
- Clinical Medicine
Background:
- Variant angina, or Prinzmetal's angina, is typically associated with ST-segment elevation on electrocardiogram.
- Spontaneous angina episodes often occur in the morning.
- Coronary vasospasm is the underlying mechanism, leading to transient myocardial ischemia.
Purpose of the Study:
- To report a unique case of variant angina presenting without ST-segment elevation.
- To investigate the mechanism of chest pain in a patient with normal coronary angiography but positive ergonovine test.
- To highlight the role of collateral circulation in atypical variant angina.
Main Methods:
- A 60-year-old male patient with a 2-year history of chest pain was evaluated.
- Coronary angiography was performed, followed by ergonovine provocation testing.
- Electrocardiogram (ECG) monitoring was conducted during the ergonovine test.
Main Results:
- Coronary angiography revealed no abnormalities at baseline.
- Ergonovine administration (100 µg) induced total occlusion of the proximal right coronary artery.
- Crucially, ST-segment elevation was absent on the ECG during vasospasm.
- The occlusion was attributed to collateral flow from the left anterior descending artery to the distal right coronary artery.
Conclusions:
- Variant angina can occur without ST-segment elevation on the electrocardiogram.
- Transient collateral circulation during vasospasm is a potential mechanism in these atypical presentations.
- Consideration of collateral pathways is important for diagnosing variant angina when ECG changes are absent.
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