scholarly journals Chest pain with ST-T changes on electrocardiogram and localized stenosis on coronary angiography could be a coronary vasospasm

2012 ◽  
Vol 3 (2) ◽  
pp. 165-166
Author(s):  
Prashant Nasa ◽  
Debabrata Dash ◽  
Bharat Jagiasi
Keyword(s):  
Chest Pain ◽  
Coronary Angiography ◽  
Coronary Vasospasm ◽  
Localized Stenosis

scholarly journals The role of computed tomography coronary angiography in multi-vessel coronary vasospasm: a case report

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
James S Tomlinson ◽  
Amit Patel ◽  
Terry Levy
Keyword(s):  
Computed Tomography ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Coronary Angiography ◽  
Cold Pressor ◽  
Coronary Plaque ◽  
Coronary Vasospasm ◽  
Coronary Syndrome ◽  
Provocation Testing ◽  
Cold Pressor Testing

Abstract Background Coronary vasospasm can present like an acute coronary syndrome (ACS) with an intense vasoconstriction resulting in total or near-total occlusion of one or more of the coronary vessels. Definitive diagnosis can be made by intracoronary provocation testing. Case summary A 37-year-old Caucasian male and smoker was admitted with chest pain. Highly sensitive troponin-I was positive at 63 ng/L (99th percentile upper reference limit, <15 ng/L) with a repeat value of 45 ng/L three and a half hours later which was of clinical significance. Serial electrocardiography (ECG) showed no ischaemic changes. Coronary angiography revealed several distal and side branch stenoses; however, angiographic appearances were atypical of coronary plaque. A differential diagnosis of spontaneous coronary artery dissection was suspected although the patient was pain free during the procedure. Computed tomography coronary angiography (CTCA) demonstrated normal coronary arteries, confirmed on repeat invasive coronary angiography. Cold pressor testing was unsuccessful in reproducing vasospasm. Acute coronary syndrome treatment was discontinued, he received smoking cessation advice and Amlodipine 5 mg daily was started. He has experienced no further episodes of cardiac chest pain on follow-up consultation 7 months later. Discussion This is an unusual case of persistent, extensive coronary vasospasm in a patient without ongoing chest pain or ischaemic ECG changes. Intracoronary nitrates are usually effective at relieving coronary spasm. Cold pressor testing has poor sensitivity for diagnosing vasospasm when compared to intracoronary provocation testing using either acetylcholine or ergonovine. Multi-slice CTCA may help to discriminate coronary plaque from coronary vasospasm when there is diagnostic uncertainty.

scholarly journals Downstream testing after CT coronary angiography: time for a rethink?

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001597
Author(s):  
Gareth Morgan-Hughes ◽  
Michelle Claire Williams ◽  
Margaret Loudon ◽  
Carl A Roobottom ◽  
Alice Veitch ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Communication Systems ◽  
Ct Coronary Angiography ◽  
Second Line ◽  
Recent Onset ◽  
Line Test ◽  
Artery Disease

ObjectiveWe surveyed UK practice and compliance with the National Institute for Health and Care Excellence (NICE) ‘recent-onset chest pain’ guidance (Clinical Guideline 95, 2016) as a service quality initiative. We aimed to evaluate the diagnostic utility and efficacy of CT coronary angiography (CTCA), NICE-guided investigation compliance, invasive coronary angiography (ICA) use and revascularisation.MethodsA prospective analysis was conducted in nine UK centres between January 2018 and March 2020. The reporter decided whether the CTCA was diagnostic. Coronary artery disease was recorded with the Coronary Artery Disease–Reporting and Data System (CAD-RADS). Local electronic records and picture archiving/communication systems were used to collect data regarding functional testing, ICA and revascularisation. Duplication of coronary angiography without revascularisation was taken as a surrogate for ICA overuse.Results5293 patients (mean age, 57±12 years; body mass index, 29±6 kg/m²; 50% men) underwent CTCA, with a 96% diagnostic scan rate. 618 (12%) underwent ICA, of which 48% (298/618) did not receive revascularisation. 3886 (73%) had CAD-RADS 0–2, with 1% (35/3886) undergoing ICA, of which 94% (33/35) received ICA as a second-line test. 547 (10%) had CAD-RADS 3, with 23% (125/547) undergoing ICA, of which 88% (110/125) chose ICA as a second-line test, with 26% (33/125) leading to revascularisation. For 552 (10%) CAD-RADS 4 and 91 (2%) CAD-RADS 5 patients, ICA revascularisation rates were 64% (221/345) and 74% (46/62), respectively.ConclusionsWhile CTCA for recent-onset chest pain assessment has been shown to be a robust test, which negates the need for further investigation in three-quarters of patients, subsequent ICA overuse remains with almost half of these procedures not leading to revascularisation.

The Value of Dual-source 64-Slice CT Coronary Angiography in the Assessment of Patients Presenting to an Acute Chest Pain Service

2010 ◽  
Vol 19 (4) ◽  
pp. 213-218 ◽  
Author(s):  
Mark Hansen ◽  
Jonathan Ginns ◽  
Sujith Seneviratne ◽  
Richard Slaughter ◽  
Manuja Premaranthe ◽  
...  
Keyword(s):  
Chest Pain ◽  
Coronary Angiography ◽  
Acute Chest Pain ◽  
Ct Coronary Angiography ◽  
Dual Source

Safety and Validity of Ergonovine Echocardiography before Coronary Angiography for Diagnosis of Coronary Vasospasm

1995 ◽  
Vol 25 (5) ◽  
pp. 910
Author(s):  
Jae-Kwan Song ◽  
Simon Jong-Koo Lee ◽  
Duk Hyun Kang ◽  
Sang Sig Cheong ◽  
Myeong Ki Hong ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Coronary Vasospasm

Computerized tomography: coronary angiography and cardiac imaging

2021 ◽  
pp. 224-245
Author(s):  
Jeff M Smit ◽  
Mohammed El Mahdiui ◽  
Michiel A de Graaf ◽  
Arthur JHA Scholte ◽  
Lucia Kroft ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Pulmonary Embolism ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Computerized Tomography ◽  
Acute Chest Pain ◽  
Non Invasive ◽  
Computerized Tomography Angiography ◽  
Artery Disease

Patients presenting with chronic and acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computerized tomography for non-invasive visualization of coronary artery disease in patients presenting with acute chest pain to the emergency department, particularly the subset of patients who are suspected of having an acute coronary syndrome, but without typical electrocardiographic changes and with normal troponin levels at presentation. As a result of rapid developments in coronary computerized tomography angiography technology, high diagnostic accuracies for excluding coronary artery disease can be obtained. It has been shown that these patients can be discharged safely. The accuracy for detecting a significant coronary artery stenosis is also high, but the presence of coronary artery atherosclerosis or stenosis does not imply necessarily that the cause of the chest pain is related to coronary artery disease. Moreover, non-invasive detection of coronary artery disease by computerized tomography has been shown to be related with an increased use of subsequent invasive coronary angiography and revascularization, and further studies are needed to define which patients benefit from invasive evaluation following coronary computerized tomography angiography. Conversely, implementation of coronary computerized tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computerized tomography is an excellent modality in patients whose symptoms suggest other causes of acute chest pain such as aortic aneurysm, aortic dissection, or pulmonary embolism. Furthermore, acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computerized tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as evaluation of coronary artery plaque composition, myocardial function and perfusion, and non-invasive assessment of fractional flow reserve from coronary computerized tomography angiography, are currently being developed and may also become valuable in the setting of chronic and acute chest pain in the future.

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