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[X syndrome. Angiographic findings]
G Nava López1, C Monteverde, R Jauregui
1Hospital de Cardiología Luis Méndez del Centro Médico Nacional del Instituto Mexicano del Seguro Social.
Insights
Coronary artery spasm is a primary cause of ischemic heart disease without atherosclerosis. Treatment with calcium antagonists led to favorable outcomes in most patients, with many becoming asymptomatic.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Coronary artery spasm is a frequent cause of ischemic heart disease (IHD) when coronary atherosclerosis is absent.
- Other potential causes of IHD like cardiomyopathy and valvular heart disease were excluded.
Purpose of the Study:
- To investigate the characteristics and outcomes of patients with IHD attributed to coronary artery spasm.
- To evaluate the efficacy of calcium antagonists in managing this condition.
Main Methods:
- Studied 23 patients (15 males, 8 females; mean age 47) with angina and myocardial ischemia but no coronary atherosclerosis.
- Utilized cardiac cineangiography, intracoronary ergonovine testing, ECG, stress tests, and thallium-201/technetium-99 scintigraphy.
- Assessed outcomes over a two-year follow-up period.
Main Results:
- Cardiac cineangiography revealed no atherosclerosis but showed reduced contrast medium progression, indicating increased coronary resistance.
- Unstable angina (UA) was diagnosed in 21 patients, and myocardial infarction (MI) in 2.
- Calcium antagonist treatment resulted in a favorable prognosis: 18 patients became asymptomatic, four had stable angina, and one had persistent unstable angina.
Conclusions:
- Coronary artery spasm is a significant cause of IHD in the absence of atherosclerosis.
- Calcium antagonists are effective in managing IHD caused by coronary artery spasm, leading to improved patient outcomes.
Abstract:
Coronary artery spasm is the most frequent cause of ischemic heart disease without coronary atherosclerosis once other causes such as cardiomyopathy, arteritis, coronary ectasia, valvular heart disease or hypertensive heart disease are eliminated. We report 23 patients, 15 males and 8 females, whose ages ranged from 34 to 63 years, with a mean age of 47 years, with demonstrated angina pectoris and myocardial ischemia, whose cardiac cineangiography showed no signs of atherosclerosis. Nevertheless, a significant retardation in the progression speed of the contrast medium was observed, as indirect evidence of the increment in coronary resistance at the arteriole level. Coronary spasm was ruled out by administration of intracoronary ergonovine, and other causes of myocardial ischemia, such as muscular bridges, were also discarded. The clinical presentation of the ischemic heart disease was unstable angina (UA) in 21 patients and myocardial infarction (MI) in 2. In the UA group, 14 patients showed ischemic changes in the ECG while the pain lasted, and in 8 patients the changes were present during the stress test. In all of them, the stress test perfusion scan with thallium 201 showed myocardial ischemia. In the IM group, the diagnosis was based on the clinical findings, the ECG, the enzyme curve, and the technetium 99 cardiac scintigram. In the two-year follow-up the prognosis has been favorable with treatment based on calcium antagonists. Nowadays 18 patients are asymptomatic, four have stable angina and only one has unstable angina.