11/94. Usefulness of massive oral nicorandil in a patient with variant angina refractory to conventional treatment.A 67-year-old man, who was previously diagnosed with vasospastic angina and treated with standard therapy, was admitted to our hospital because of recurrent chest pain refractory to sublingual nitroglycerin. Admission electrocardiography revealed ST segment elevation in II, III and aV(F), and his symptoms were relieved by intravenous bolus administration of nicorandil. He was diagnosed to have active variant angina, and remained symptomatic even after treatment with calcium antagonists and nitrates at optimal doses. Intravenous bolus administration of nicorandil was consistently effective to relieve his symptoms. Anginal attack was finally prevented by massive oral nicorandil in addition to conventional treatment.- - - - - - - - - - ranking = 1keywords = chest pain, chest, pain (Clic here for more details about this article) |
12/94. Two cases of variant form angina pectoris associated with myocardial bridge--a possible relationship among coronary vasospasm, atherosclerosis and myocardial bridge.Myocardial bridge (MB) is a congenital anomaly of the coronary artery and may occur in 5 to 12% of the human population. However, the mechanism of MB-induced myocardial ischemia is still speculative. We report 2 cases of variant form angina pectoris associated with MB in which myocardial ischemia seemed to be related to the interaction between coronary perfusion and MB. In case 1, electrocardiography during anginal attack at rest showed ST elevation in the inferior leads and MB was observed after percutaneous transluminal coronary angioplasty at the site of the right coronary artery lesion following successful dilatation. In case 2, MB of the left anterior descending coronary was located in the identical portion where coronary vasospasm was induced by intracoronary acetylcholine injection, although ischemia during the spontaneous anginal attack was limited to the inferior area of myocardium. These 2 cases suggest that MB can be, at least in some patients, one of the possible causes of the endothelial damage which seems to be related to coronary vasospasm; this was documented in both cases.- - - - - - - - - - ranking = 1.9343314294713E-5keywords = area (Clic here for more details about this article) |
13/94. Transient giant R-wave, right axis deviation, and intraventricular conduction delay during exercise treadmill testing: a case report.A 53 year old man complained of chest pain during an exercise treadmill test. Electrocardiogram revealed transient giant R-wave, right-axis deviation, intraventricular conduction delay, and ST-segment elevation in the inferolateral leads. Subsequent coronary angiography showed an 80% lesion in mid part of a nondominant left circumflex artery, whereas the other coronary arteries had mild atherosclerosis only. percutaneous coronary intervention and stenting was performed on the left circumflex artery lesion. A follow-up exercise thallium scan 3 months later still showed an intermediate-sized, mild reversible perfusion defect in the inferior and lateral wall but the giant R-wave ECG pattern was not inducible anymore. Restudy coronary angiography showed no in-stent restenosis, but there was disease progression in the midpart of the right coronary artery. The initial electrocardiographic pattern is typical of the "giant R-wave syndrome." Severe coronary spasm superimposed on the underlying mild atherosclerotic lesion of the right coronary artery is hypothesized to be the cause of the initial event. Ad hoc direct stenting was performed on the right coronary artery lesion. The patient remained symptom-free with a normal thallium scan 9 months later.- - - - - - - - - - ranking = 1keywords = chest pain, chest, pain (Clic here for more details about this article) |
14/94. Variant angina in a 17-year-old male.chest pain is a common complaint in adolescents. It is mostly from musculoskeletal origin.Variant angina is a rare cause of chest pain in adolescents. Here we report a 17-year-old male with severe chest pain accompanied by transient ST-segment elevation in leads II, III, avF of the electrocardiogram showing/revealing variant angina associated with acute myocardial ischaemia. Data obtained from laboratory tests, including serial cardiac markers, were normal and subsequent cardiac catheterization revealed a normal coronary anatomy. The patient has been asymptomatic since discharge, and treatment with calcium channel antagonists with nitrate seems to assure a good prognosis.- - - - - - - - - - ranking = 2.0028095772361keywords = chest pain, chest, pain (Clic here for more details about this article) |
15/94. Unusual case of single coronary artery: questions of methods and basic concepts.Coronary artery anomalies continue to constitute a confusing subject in modern cardiology. While most anomalies are considered to have a benign prognosis, the literature and cardiologic culture frequently imply an intrinsic, systematic association of coronary anomalies with severe clinical presentations. We present a case of unusual single coronary artery, in order to elucidate the logical process that should be used to study similar cases. A 56-year-old female presented with a 6-year history of atypical chest pain and an abnormal electrocardiogram. heart catheterization revealed an abnormal coronary tree interpreted by some observers as a benign coronary anomaly, by others to indicate the need for coronary angioplasty. A nuclear stress test was performed after 1 year of unrelenting symptoms and showed mildly abnormal findings, leading to a more definitive angiographic study that clarified the anatomy and the prognosis. The case is essentially and only an example of single coronary artery with origin of all branches from the right coronary sinus, but with an unusual triple origin of the branches serving the left anterior descending territory. The notion that a case of single coronary artery may have significant prognostic and clinical repercussion is frequently repeated in the current inconclusive literature. A rational discussion should deal both with individual case objective evidence and theoretical general consideration.- - - - - - - - - - ranking = 1keywords = chest pain, chest, pain (Clic here for more details about this article) |
16/94. Type I CD36 deficiency associated with metabolic syndrome and vasospastic angina: a case report.A 54-year-old man was admitted to our hospital for evaluation of chest pain occurring at rest in the morning. ST segment depression was observed during a treadmill exercise test. coronary angiography identified spontaneous spasm of the proximal right coronary artery, and right coronary obstruction was improved from 90% to about 50% stenosis after intracoronary administration of nitroglycerin. Myocardial iodine-123 beta-methyl-p-iodophenyl-pentadecanoic acid uptake was absent, but thallium-201 uptake during single photon emission computed tomography was normal, and neither platelet nor monocyte expression of the CD36 molecule was observed, indicating type I CD36 deficiency. High blood pressure, elevated plasma triglyceride and fasting plasma glucose levels, and low high-density lipoprotein values suggested metabolic syndrome. The final diagnosis was type I CD 36 deficiency associated with metabolic syndrome and vasospastic angina.- - - - - - - - - - ranking = 1keywords = chest pain, chest, pain (Clic here for more details about this article) |
17/94. angina pectoris due to possible vasospasm of small coronary arteries.Recently, the presence of vasospasm in small coronary arteries is speculated in animals and humans. A 40-year-old female patient complained of chest pain at rest. Left ventriculogram showed normal wall motions. Left and right coronary arteries were also normal. After methylergometrine maleate was selectively administered to a right coronary artery, she complained of chest pain, and ST-segment elevation was detected in leads II, III, and aVF of ECG. Right coronary arteriography was performed immediately, but no coronary stenosis was found. The next day, methylergometrine maleate was again administered intravenously and the patient complained of chest pain, but no ischemic changes were observed in ECG. thallium-201 myocardial scintigraphy followed immediately. Apical perfusion defect was detected in stress image. In the delayed image, it showed complete redistribution. Three days later, catheterization and scintigraphy were performed at the same time. When methylergometrine maleate was administered to the left coronary artery, she complained of chest pain within a few minutes of the injection; however, ECG remained unchanged. 201Tl myocardial scintigraphy was performed immediately. In the stress image, it showed apical perfusion defect as shown in the intravenous methylergometrine maleate injection study. It also showed complete redistribution in the delayed image. Apical perfusion defect can be attributed to myocardial ischemia of left coronary artery, which are too small to be detected by conventional coronary arteriography. Vasospasm in small coronary arteries may be involved in this phenomenon.- - - - - - - - - - ranking = 4keywords = chest pain, chest, pain (Clic here for more details about this article) |
18/94. Prinzmetal angina. Multifocal ischemia, recurrent AV block, and bradycardia with patent coronary arteries responsive to verapamil.coronary vasospasm may result in recurrent angina pectoris and cause acute myocardial infarction. The extent to which the "sudden death syndrome" occurs is unknown. The case described herein is unique in that the clinical features, including hypotension, AV block, and ventricular arrhythmias, were similar to those seen in myocardial infarction with a poor prognosis, yet infarction was not documented. In subsequent, long-term follow-up evaluation, chest pain has been recurrent, but despite close observation, no further major cardiac complications have been documented. Long-term use of verapamil has contributed to better control of clinical symptomatology.- - - - - - - - - - ranking = 1keywords = chest pain, chest, pain (Clic here for more details about this article) |
19/94. Anginal attack following a sodium bicarbonate and hydrocortisone injection.A case of a 73-year-old man with variant angina who developed chest pain and shock following an injection of sodium bicarbonate and hydrocortisone is reported. The electrocardiogram (ECG) during the chest pain attack revealed ST elevation in leads II, III and aVF. It returned to a normal pattern 10 min later. coronary angiography, performed 2 hours after the anginal attack, showed no significant coronary arterial stenosis. One month later, an injection of ergonovine (16 micrograms) into the right and left coronary arteries induced spasms in segments 4 and 13, with ischemic ECG changes. Possible causes of the anginal attack are a coronary arterial spasm induced by the allergic reaction to hydrocortisone and/or serum alkalosis due to the sodium bicarbonate injection triggered by hyperventilation.- - - - - - - - - - ranking = 2keywords = chest pain, chest, pain (Clic here for more details about this article) |
20/94. Programmed ventricular stimulation during variant angina: report of a case.Programmed ventricular stimulation was performed in a 74-year-old patient who had a history of syncope following chest pain. In the baseline state, ventricular tachycardia was not inducible. Immediately following the study protocol, the patient complained of her usual chest pain and ST elevation was documented in lead II with reciprocal ST depression in leads AVF and V1. Programmed ventricular stimulation was repeated (presumably during the occlusive phase of coronary spasm) and a polymorphic ventricular tachycardia with a cycle length of 200 msec was repeatedly induced. Following intravenous nitroglycerin and resolution of chest pain, ventricular tachycardia was not inducible. coronary angiography with ergonovine testing confirmed coronary spasm of the right coronary artery. We speculate that syncope was caused by ventricular tachycardia following coronary artery spasm. During a 12-month follow-up with calcium blockers and nitrates, there has been no recurrence of chest pain or syncope.- - - - - - - - - - ranking = 4keywords = chest pain, chest, pain (Clic here for more details about this article) |
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