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Importance of a second spasm provocation test: Four cases with an initial negative spasm provocation test.
Hiroki Teragawa1, Yuichi Fujii1, Yuko Uchimura1
1Hiroki Teragawa, Yuichi Fujii, Yuko Uchimura, Tomohiro Ueda, Department of Cardiovascular Medicine, JR Hiroshima Hospital, Higashi-ku, Hiroshima 732-0057, Japan.
World Journal of Cardiology
|April 13, 2017
Summary
A negative spasm provocation test (SPT) does not always rule out vasospastic angina (VSA). Repeating the SPT can help diagnose VSA in patients with persistent chest symptoms.
Area of Science:
- Cardiology
- Diagnostic Testing
- Internal Medicine
Background:
- The spasm provocation test (SPT) is a key diagnostic tool for vasospastic angina (VSA).
- A negative SPT is often considered definitive for excluding VSA.
- Some patients present with persistent chest symptoms despite a negative initial SPT.
Observation:
- This study details four cases of patients experiencing chest symptoms after a negative SPT.
- These patients underwent a second SPT at intervals ranging from 2 to 4 years.
- Three out of the four patients (75%) had a positive result on the second SPT.
Findings:
- A negative SPT result should not definitively exclude VSA if clinical suspicion remains high.
- Repeat SPT may be necessary for accurate VSA diagnosis in select patient populations.
- Clinical presentation is crucial in guiding VSA diagnosis, even with initial negative test results.
Implications:
- Clinicians should consider repeating the SPT in patients with ongoing chest symptoms and a prior negative result.
- This finding may impact diagnostic algorithms for vasospastic angina.
- Further research could explore the optimal timing and criteria for repeat SPT in suspected VSA.