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Refractory variant angina controlled with combined drug therapy in a patient with a single coronary artery
Insights
A young man with refractory variant angina and a single left coronary artery experienced coronary artery spasm. A combination of four medications was required to resolve his persistent chest pain and ST segment elevation.
Area of Science:
- Cardiology
- Vascular Medicine
- Pharmacology
Background:
- Variant angina (Prinzmetal's angina) is characterized by coronary artery spasm causing chest pain.
- Refractory cases pose a significant clinical challenge, often requiring multifaceted treatment strategies.
Observation:
- A young male patient presented with a single left coronary artery and severe, refractory variant angina.
- Coronary arteriography revealed spontaneous coronary artery spasm at a site of 50% left anterior descending stenosis.
- Frequent episodes of rest angina with transient ST segment elevation persisted despite treatment with three calcium antagonist drugs.
Findings:
- Complete symptom resolution was achieved only with a combination of nifedipine, diltiazem, isosorbide dinitrate, and topical nitroglycerin.
- Ergonovine testing was utilized to objectively evaluate the patient's response to the intensive medical regimen.
Implications:
- This case highlights the potential for severe coronary artery spasm in individuals with anatomical variations like a single coronary artery.
- A combination therapy approach may be necessary for managing refractory variant angina unresponsive to standard treatments.
- Objective assessment tools like ergonovine testing are crucial for guiding and validating treatment efficacy in complex coronary artery spasm cases.
Abstract:
A young man with a single left coronary artery and refractory variant angina is described. Spontaneous coronary artery spasm developed during coronary arteriography at the site of a 50% fixed left anterior descending coronary artery stenosis. Frequent episodes of rest angina with transient ST segment elevation persisted in hospital in spite of treatment with three different calcium antagonist drugs. Symptoms disappeared only when the combination of nifedipine, diltiazem, isosorbide dinitrate, and nitroglycerin ointment were given. Ergonovine testing was used to objectively assess the response to treatment.