Transient predominant right ventricular ischemia caused by coronary vasospasm

Area of Science:

• Cardiology
• Nuclear Cardiology
• Cardiovascular Imaging

Background:

• Variant angina, often caused by coronary artery spasm, typically affects the left ventricle.
• Right coronary artery spasm is less commonly associated with right ventricular ischemia.

Purpose of the Study:

• To investigate the prevalence and detection of right ventricular involvement in patients with variant angina due to right coronary artery spasm.
• To compare clinical findings in patients with and without right ventricular ischemia during right coronary artery spasm.

Main Methods:

• Clinical assessment of four patients with suspected predominant right ventricular ischemia during variant angina.
• Utilized thallium-201 scans, radionuclide angiography (RNA), echocardiography, and hemodynamic monitoring.
• Compared findings with four patients exhibiting left ventricular involvement during similar ischemic episodes.

Main Results:

• Documented right ventricular ischemia in all four studied patients using first-pass radionuclide studies and RNA phase analysis.
• Confirmed right ventricular ischemia with hemodynamic monitoring in three patients.
• Demonstrated that normal left ventricular function tests can indicate predominant right ventricular ischemia.

Conclusions:

• Right ventricular ischemia is prevalent in variant angina caused by right coronary artery vasospasm.
• Suspect right ventricular involvement when anginal symptoms occur with normal left ventricular function.
• First-pass radionuclide study and RNA phase analysis are effective for detecting transient right ventricular dysfunction.