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[Acute myocardial ischemia in spontaneous coronary artery spasm]
R M Klein1, R Niehues, M P Heintzen
1Klinik für Kardiologie, Pneumologie und Angiologie, Universität Düsseldorf.
Insights
Spontaneous coronary artery spasms cause myocardial ischemia, especially in younger men with hypercholesterolemia and heavy smoking. Key indicators include rest angina with reversible ECG changes and minimal coronary sclerosis.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Myocardial ischemia can stem from various causes, including spontaneous coronary artery spasms.
- Identifying specific indicators for vasospastic angina is crucial for accurate diagnosis and treatment.
Purpose of the Study:
- To determine the clinical factors and angiographic findings associated with spontaneous coronary artery spasms as a cause of myocardial ischemia.
Main Methods:
- Retrospective analysis of 1407 patients undergoing coronary arteriography.
- Evaluation of clinical data and follow-up information for 15 patients diagnosed with spontaneous coronary artery spasms.
Main Results:
- Hypercholesterolemia (66%) and heavy nicotine consumption (55%) were the most frequent risk factors.
- Patients presented with angina at rest, reversible ST elevations, T-wave negativity, and ventricular arrhythmias.
- Coronary angiography showed reversible constrictions, with varying degrees of stenosis and intermittent occlusions, often with smooth arterial walls.
Conclusions:
- Spontaneous coronary artery spasms should be suspected in younger male patients with hypercholesterolemia and heavy smoking.
- Recurrent angina at rest, reversible ischemic ECG changes, and absence of advanced coronary atherosclerosis are indicative of vasospastic angina.
Aim Of Study:
To discover what factors indicate spontaneous coronary artery spasms as a cause of myocardial ischaemia.
Patients And Method:
In a retrospective analysis 15 of 1407 consecutive patients who had undergone coronary arteriography (six women and nine men; mean age 47 +/- 11 years) had acute ischaemia due to spontaneous coronary artery spasms. The clinical findings at the time of first investigation and during the follow-up period (mean of 29 [3-65] months) were evaluated.
Results:
The most common risk factors were hypercholesterolaemia (> or = 200 mg/dl) in ten patients (66%) and heavy nicotine consumption > or = 20 cigarettes per day) in eight patients (55%). Of the patients with angina at rest nine had reversible ST elevations, six had terminal T negativity in the ECG and an increased incidence of ventricular arrhythmias (n = 6). At time of hospitalization ten patients had acute myocardial ischaemia and five had signs of acute myocardial infarction (maximal creatine kinase concentration: 121-2980 U/l). Acute coronary angiography revealed circumscribed coronary artery constriction, reversible with nitroglycerin, with stenosis of < 70% in five patients and of > or = 70% in six, as well as intermittent vessel occlusion in four patients. Angiography showed smooth coronary artery walls in almost all instances. Angiographic evidence of circumscribed arteriosclerotic lesion with maximally 50% narrowing was present in six patients.
Conclusion:
Especially in younger, male patients with hypercholesterolaemia and heavy smoking recurrent anginal pectoris at rest, with reversible ECG signs of myocardial ischaemia but without advanced coronary sclerosis, speaks for spontaneous coronary artery spasms as the cause.