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Coronary vasospasm during CT angiography

Takehiro Nakahara1, Takuji Toyama2, Yoshito Tsushima3

  • 1Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan.

Journal of Cardiovascular Computed Tomography
|July 29, 2014
PubMed

Insights

Vasospastic angina can be challenging to diagnose, even with cardiac CT. Beta-blockers, while common for CT, may mask symptoms of this condition in susceptible patients.

Area of Science:

  • Cardiology
  • Diagnostic Imaging

Background:

  • Coronary artery disease diagnosis often involves cardiac CT.
  • Beta-blockers are frequently administered during cardiac CT procedures.
  • Vasospastic angina is a condition characterized by reversible coronary artery spasms.

Observation:

  • A 71-year-old male smoker presented with post-dinner chest oppression.
  • Cardiac CT with beta-blocker revealed coronary stenosis, but adenosine triphosphate-stress perfusion SPECT showed no ischemia.
  • Holter monitoring later detected ST elevation during symptomatic episodes while smoking.

Findings:

  • The patient was diagnosed with vasospastic angina.
  • Cardiac CT performed without a beta-blocker showed non-obstructive, diffuse plaque and negative remodeling.
  • Asian populations exhibit a higher prevalence of vasospastic angina.

Implications:

  • Routine beta-blocker use in cardiac CT may obscure the diagnosis of vasospastic angina.
  • Careful consideration of patient history and potential vasospastic angina is crucial.
  • Alternative diagnostic strategies may be necessary for patients at risk for vasospastic angina.

Keywords:
Asian patientsBeta-blockersCardiac CTLandiololRoutine useVasospastic angina

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