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Severe coronary vasospasm associated with hyperthyroidism causing myocardial infarction
REVISITATION
SERIES
Three months later, after radioactive iodine treatment had rendered her euthyroid, repeat coronary angiography showed entirely normal coronary arteries, This unusual case establishes an association between hyperthyroidism and coronary vasospasm resulting in myocardial infarction.
THE ENDOTHELIUM Fluctuation Vasospastic Study
of Spastic location in Patients With Angina: A Quantitative Angiographic
V. Dzaki, D. Keane, P.W. 5ermy-s. Thoraxcenter, Erasmus Universiq, Rotterdam, The Netherlands. ] Am Coil Cardiol 1995;26:1606-14.
Objectives: This study sought to determinewhether the loca-
A New Noninvasive Method of Diagnosing Vasospastic Angina Based on Dilation Response of the Left Main Coronary Artery to Nitroglycerin as Measured by Echocardiography
tion of coronary spastic activity may change over time in patients with persistent variant angina. Background: Although electrocardiographic studieshave provided indirect evidence to indicate that the location of ischemia may changein patientswith variant angina,it hasnot been tested by quantitative angiography whether the location of vasospastic activity may change over time. Methods:Paired ergonovine provocation testsand coronary angiography were performed at a mean (*SD) interval of 43 IfI 13 months apart in patients with persistent symptoms of vasospastic anginain the absenceof significant atherosclerosis.A total of 87 spasticand nonspasticsegmentsof 87 major vesselsin 29 patients were analyzed by quantitative angiography at baseline, after the administration of ergonovine and after isosorbide dinitrate at the initial and follow-up tests.Results:In 13 patients (group l), coronary spasmwas observed in the same16 coronary segmentsat both the initial and follow-up ergonovine provocation tests. In 16 patients (group 2), the following angiographicchangesoccurred between the initial and follow-up testsin 48 major vessels:Of the 23 segments that developed spasmat the initial test, 10 did not have spasmat the follow-up test; of the 25 vesselsthat did not demonstrate spasm on the initial test, 12 demonstrated spasmon the follow-up test (a new site of spasm).Thus, in 22 (46%) of 48 vessels,fluctuation of spasticlocation was observedat follow-up. Conclusions:Quantitative coronary angiography and repeated ergonovine tests revealed that some patients with persistent vasospastic angina demonstrate fluctuation of vasospastic location, whereas others exhibit a fixed location of vasospasm.Vasospastic angina may not only be a transient diseaserestricted in location, but may also be a persistent and variable condition involving multiple vessels over many years.
H. Morita, K. Ohmori, T. Matsuyama, K Mizushige, H. Matsuo. Second Dept of Internal Medicine, Kagawa Medical School, Kagam Japan. J Am toll Cardiol 199627: 1450-7.
Objectives:The purpose of the presentstudy wasto evaluate the feasibility of diagnosing vasospasticangina based on coronary artery tone as assessedby M-mode echocardiographic measurementof the dilation responseof the left main coronary artery to nitroglycerin. Background:The definite diagnosisof vasospasticangina is done by a coronary spasmprovocative test using ergonovine maleateor acetylcholine during cardiac catheterization. Current noninvasive, nonpharmacologic diagnostic methods are not sensitive enough for the diagnosis of vasospasticangina. Methods: Thirty-eight patients who had an angiographically normal left main trunk were studied. Thesepatients were classified into four groups basedon the presenceor absenceof more than 50% stenosisin the coronary arteriesexcept for the left main trunk and the results of the acetylcholine or ergonovine provocative test. At 7 a.m. and at noon on the sameday, the left main trunk diameter was measured by M-mode echocardiography before and after sublingual administration of nitroglycerin (0.3 mg), and its percent dilation was calculated to assess coronary artery tone. Results:The percent dilation of the left main trunk diameter induced by sublingual nitroglycerin at 7 a.m. and at noon was 22.4% and 18.1% in 11 patients with vasospasticangina and without coronary stenosis,14.9% and 11.2% in 9 patients with vasospasticanginaand coronary stenosis,6.1% and 7.0% in 8 patients without vasospasticangina but with coronary stenosisand 8.1% and 7.8% in 10 control subjects. The percent dilation at 7 a.m. was significantly greater in the vasospasticanginawithout coronary stenosisgroup than in the remaining three groups, and in the vasospasticangina groups, the percent dilation at 7 a.m. was significantly greater than that at noon. When percent dilation at 7 a.m. exceeding 15% was defined as positive for the diagnosisof vasospasticangina,the sensitivity was80% and the specificity 94%. Conclusions:Basal tone of the left main trunk is elevated in the early morning in vasospastic angina. Dilation of the left main trunk diameter exceeding 15% induced by sublingual nitroglycerin in the early morning
Severe Coronary Vasospasm Associated With Hyperthyroidism Causing Myocardial Infarction M.D. Masani, D.B. Northridge, K.J. Hall. Department of Cardiology, University Hospital of Wales, Cardiff, Great Britain. Br Heart J 1995;74:700-I.
A 48 year old woman presentedwith anginaafter an anterior myocardial infarction and was found to be hyperthyroid. Coronary angiography showeda stenosisof the left coronary OSand a long, severestenosisof the left anterior descending artery which was partially relieved by glyceryl trinitrate. ACC
CURRENT
JOURNAL
REVIEW
23
March/April
1997
SERIES
Three months later, after radioactive iodine treatment had rendered her euthyroid, repeat coronary angiography showed entirely normal coronary arteries, This unusual case establishes an association between hyperthyroidism and coronary vasospasm resulting in myocardial infarction.
THE ENDOTHELIUM Fluctuation Vasospastic Study
of Spastic location in Patients With Angina: A Quantitative Angiographic
V. Dzaki, D. Keane, P.W. 5ermy-s. Thoraxcenter, Erasmus Universiq, Rotterdam, The Netherlands. ] Am Coil Cardiol 1995;26:1606-14.
Objectives: This study sought to determinewhether the loca-
A New Noninvasive Method of Diagnosing Vasospastic Angina Based on Dilation Response of the Left Main Coronary Artery to Nitroglycerin as Measured by Echocardiography
tion of coronary spastic activity may change over time in patients with persistent variant angina. Background: Although electrocardiographic studieshave provided indirect evidence to indicate that the location of ischemia may changein patientswith variant angina,it hasnot been tested by quantitative angiography whether the location of vasospastic activity may change over time. Methods:Paired ergonovine provocation testsand coronary angiography were performed at a mean (*SD) interval of 43 IfI 13 months apart in patients with persistent symptoms of vasospastic anginain the absenceof significant atherosclerosis.A total of 87 spasticand nonspasticsegmentsof 87 major vesselsin 29 patients were analyzed by quantitative angiography at baseline, after the administration of ergonovine and after isosorbide dinitrate at the initial and follow-up tests.Results:In 13 patients (group l), coronary spasmwas observed in the same16 coronary segmentsat both the initial and follow-up ergonovine provocation tests. In 16 patients (group 2), the following angiographicchangesoccurred between the initial and follow-up testsin 48 major vessels:Of the 23 segments that developed spasmat the initial test, 10 did not have spasmat the follow-up test; of the 25 vesselsthat did not demonstrate spasm on the initial test, 12 demonstrated spasmon the follow-up test (a new site of spasm).Thus, in 22 (46%) of 48 vessels,fluctuation of spasticlocation was observedat follow-up. Conclusions:Quantitative coronary angiography and repeated ergonovine tests revealed that some patients with persistent vasospastic angina demonstrate fluctuation of vasospastic location, whereas others exhibit a fixed location of vasospasm.Vasospastic angina may not only be a transient diseaserestricted in location, but may also be a persistent and variable condition involving multiple vessels over many years.
H. Morita, K. Ohmori, T. Matsuyama, K Mizushige, H. Matsuo. Second Dept of Internal Medicine, Kagawa Medical School, Kagam Japan. J Am toll Cardiol 199627: 1450-7.
Objectives:The purpose of the presentstudy wasto evaluate the feasibility of diagnosing vasospasticangina based on coronary artery tone as assessedby M-mode echocardiographic measurementof the dilation responseof the left main coronary artery to nitroglycerin. Background:The definite diagnosisof vasospasticangina is done by a coronary spasmprovocative test using ergonovine maleateor acetylcholine during cardiac catheterization. Current noninvasive, nonpharmacologic diagnostic methods are not sensitive enough for the diagnosis of vasospasticangina. Methods: Thirty-eight patients who had an angiographically normal left main trunk were studied. Thesepatients were classified into four groups basedon the presenceor absenceof more than 50% stenosisin the coronary arteriesexcept for the left main trunk and the results of the acetylcholine or ergonovine provocative test. At 7 a.m. and at noon on the sameday, the left main trunk diameter was measured by M-mode echocardiography before and after sublingual administration of nitroglycerin (0.3 mg), and its percent dilation was calculated to assess coronary artery tone. Results:The percent dilation of the left main trunk diameter induced by sublingual nitroglycerin at 7 a.m. and at noon was 22.4% and 18.1% in 11 patients with vasospasticangina and without coronary stenosis,14.9% and 11.2% in 9 patients with vasospasticanginaand coronary stenosis,6.1% and 7.0% in 8 patients without vasospasticangina but with coronary stenosisand 8.1% and 7.8% in 10 control subjects. The percent dilation at 7 a.m. was significantly greater in the vasospasticanginawithout coronary stenosisgroup than in the remaining three groups, and in the vasospasticangina groups, the percent dilation at 7 a.m. was significantly greater than that at noon. When percent dilation at 7 a.m. exceeding 15% was defined as positive for the diagnosisof vasospasticangina,the sensitivity was80% and the specificity 94%. Conclusions:Basal tone of the left main trunk is elevated in the early morning in vasospastic angina. Dilation of the left main trunk diameter exceeding 15% induced by sublingual nitroglycerin in the early morning
Severe Coronary Vasospasm Associated With Hyperthyroidism Causing Myocardial Infarction M.D. Masani, D.B. Northridge, K.J. Hall. Department of Cardiology, University Hospital of Wales, Cardiff, Great Britain. Br Heart J 1995;74:700-I.
A 48 year old woman presentedwith anginaafter an anterior myocardial infarction and was found to be hyperthyroid. Coronary angiography showeda stenosisof the left coronary OSand a long, severestenosisof the left anterior descending artery which was partially relieved by glyceryl trinitrate. ACC
CURRENT
JOURNAL
REVIEW
23
March/April
1997