Ergonovine testing in a coronary care unit

Area of Science:

• Cardiology
• Diagnostic Procedures

Background:

• Variant angina, a form of coronary artery spasm, can be challenging to diagnose without electrocardiogram (ECG) changes during an episode.
• Ergonovine testing is a provocative test used to assess for coronary artery spasm.

Purpose of the Study:

• To evaluate the efficacy and safety of ergonovine testing in diagnosing variant angina.
• To determine the correlation between ergonovine test results and clinical presentation.

Main Methods:

• 100 consecutive patients underwent ergonovine testing following coronary arteriography.
• Ergonovine was administered in incremental doses (0.0125-0.4 mg) with S-T elevation >1 mm as the criterion for a positive test.
• Patients were categorized based on chest pain history and ECG findings during pain.

Main Results:

• The test was positive in all 17 patients with known variant angina and 40% of those with strongly suggestive symptoms but no recorded ECG.
• Only 2.6% of patients with atypical chest pain had a positive test.
• Serious complications occurred in 4 of 36 positive tests, including hypotension, recurrent angina, and subendocardial infarction.

Conclusions:

• Ergonovine testing is valuable for diagnosing variant angina in patients with a typical clinical history but without ECG documentation during pain.
• Despite its utility, the test is associated with a small but significant risk of adverse events, necessitating careful administration and monitoring.