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Does a negative ergonovine provocation test truly predict freedom from variant angina?
Yun Gi Kim1, Hyun Jin Kim, Won-Suk Choi
1Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Korean Circulation Journal
|April 25, 2013
Summary
The ergonovine provocation test can yield false negatives for variant angina diagnosis. This highlights the need to consider anti-anginal medications even with negative test results in high-risk patients.
Area of Science:
- Cardiology
- Diagnostic Medicine
Background:
- Variant angina (coronary artery vasospasm) is a critical cause of chest pain.
- The ergonovine provocation test is a standard diagnostic tool for variant angina.
- Accurate diagnosis is crucial to prevent adverse cardiovascular events.
Purpose of the Study:
- To report a case of acute myocardial infarction and cardiogenic shock due to coronary artery vasospasm.
- To highlight the potential for false-negative results from the ergonovine provocation test.
- To emphasize the importance of clinical suspicion in diagnosing variant angina.
Main Methods:
- Case report of a patient with atypical chest pain.
- Coronary angiography and ergonovine provocation tests were performed.
- Clinical course and diagnostic outcomes were analyzed.
Main Results:
- Initial ergonovine provocation tests were negative.
- The patient later developed acute myocardial infarction and cardiogenic shock.
- Coronary artery vasospasm was identified as the cause.
Conclusions:
- The ergonovine provocation test may produce false-negative results.
- Clinical history suggestive of variant angina warrants consideration of treatment despite negative tests.
- Calcium channel blockers or nitrates may be indicated in suspected variant angina cases with negative ergonovine tests.
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