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Vasospastic angina mimicking graft failure and spontaneously appearing after left ventriculography
Insights
Recurrent angina in a patient with left main coronary artery stenosis was linked to coronary artery vasospasm. Left ventriculography during cardiac catheterization triggered diffuse left coronary artery spasm, suggesting a causal relationship.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- A 49-year-old female presented with recurrent angina following surgery for 75% left main coronary artery stenosis.
- Initial assessment suggested early saphenous vein graft obstruction to the left anterior descending artery.
Observation:
- During a second cardiac catheterization, left ventriculography was performed.
- Immediately following ventriculography, the patient experienced angina.
- Angiography revealed diffuse spasm of the entire left coronary artery system distal to the stenosis.
Findings:
- The observed vasospasm was temporally associated with the left ventriculogram.
- Normal left ventricular contractility ruled out ischemia as the cause of spasm.
- This suggests left ventriculography can induce coronary artery vasospasm in susceptible individuals.
Implications:
- Coronary artery vasospasm can be triggered by left ventriculography.
- This finding is crucial for interpreting angina during cardiac catheterization.
- Understanding this relationship aids in accurate diagnosis and management of coronary artery disease.
Abstract:
A 49-year-old female with significant (75%) left main coronary artery stenosis was initially considered to have developed early obstruction of a saphenous vein graft to the left anterior descending coronary artery, because of recurrent postoperative angina. In a second catheterization study, left ventriculography showed normal contractility of all segments and was immediately followed by the onset of angina and angiographic demonstration of diffuse spasm of the entire left coronary artery system beyond the stenosis. Vasospasm of the left coronary artery before or during ventriculography was unlikely in the absence of regional contractility impairment. The close temporal association between the left ventricular angiogram and the angiographic demonstration of vasospasm suggested a direct cause and effect relationship.