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A case of rest angina due to microvascular spasm
H Yamagishi1, H Itagane, K Hato
1Department of Cardiology, Osaka City General Hospital, Japan.
Insights
This study highlights a rare case of angina pectoris caused by microvascular spasm, diagnosed during cardiac catheterization. The findings demonstrate spontaneous resolution of coronary artery spasm during the procedure.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Angina pectoris, characterized by chest pain, can stem from various causes, including coronary artery disease and microvascular dysfunction.
- Microvascular spasm, a condition affecting the small arteries of the heart, can lead to angina symptoms but is often challenging to diagnose.
- Cardiac catheterization is a standard procedure for investigating coronary artery disease, offering insights into coronary anatomy and blood flow.
Observation:
- A 66-year-old woman experienced spontaneous chest pain with ST elevation during cardiac catheterization.
- Coronary arteriography showed no significant blockages but a transient, marked delay in contrast perfusion of the left anterior descending artery.
Findings:
- The patient was diagnosed with angina pectoris attributed to microvascular spasm.
- This diagnosis was confirmed by the spontaneous resolution of symptoms and arteriographic findings within minutes.
Implications:
- This case highlights the importance of considering microvascular spasm in patients with angina, even without obstructive coronary artery disease.
- Demonstrating microvascular spasm via coronary arteriography during a spontaneous event is exceptionally uncommon and valuable for understanding vasospastic angina.
Abstract:
A 66-year-old woman underwent elective cardiac catheterization for investigation of periodic attacks of chest pain at rest. During the examination, a chest pain attack occurred unexpectedly, resulting in ST elevation in the precordial leads on electrocardiography. Immediate coronary arteriography demonstrated no organic stenosis but markedly delayed contrast medium perfusion in the mild to distal portion of the left anterior descending artery. These phenomena spontaneously disappeared about 3 min later, and the patient was diagnosed as having angina pectoris due to microvascular spasm. The demonstration of angina pectoris due to microvascular spasm by coronary arteriography during a spontaneous attack is very rare.