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Diagnosis and treatment of coronary spasm in China: a case report

Hongyang Zhang1,2, Xianglin Ye1,2, Haifeng Pei1,2

  • 1Department of Cardiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China.

Frontiers in Cardiovascular Medicine
|September 2, 2024
PubMed

Insights

Coronary vasospasm (CVS) is a common condition often misdiagnosed. Intravascular ultrasound (IVUS) aids in diagnosing CVS, especially when provocative tests are unsuitable, highlighting the need for standardized Chinese protocols.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Interventional Cardiology

Background:

  • Coronary vasospasm (CVS) is a prevalent cardiovascular condition with significant patient impact.
  • Current diagnostic and treatment standards for CVS in China lack standardization, affecting patient outcomes.
  • Myocardial bridging can coexist with and complicate the diagnosis of CVS.

Observation:

  • A 68-year-old male with recurrent chest pain presented with nocturnal symptoms and elevated troponin.
  • Emergency coronary angiography revealed severe (95%-99%) segmental narrowing in the left anterior descending and right coronary arteries.
  • Intravascular ultrasound demonstrated negative remodeling and a minimal lumen area of 2.19 mm² in a myocardial bridge segment.

Findings:

  • Intracoronary nitroglycerin administration significantly increased the lumen area from 2.19 mm² to 8.81 mm².
  • The patient received a definitive diagnosis of coronary vasospasm (CVS) with coronary artery myocardial bridging.
  • Adjusted medication treatment led to symptom resolution and successful discharge.

Implications:

  • Coronary angiography (CAG) combined with intravascular ultrasound (IVUS) offers an alternative diagnostic approach for CVS when provocative agents are contraindicated.
  • There is an urgent need for improved epidemiological data and standardized diagnostic and treatment protocols for CVS in China.
  • Accurate diagnosis and tailored treatment of CVS, particularly in the context of myocardial bridging, can significantly improve patient quality of life.
Abstract

Keywords:
anginacoronary angiographycoronary vasospasmintracoronary ultrasoundmyocardial bridging

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