Electrophysiologic study and ergonovine provocation of coronary spasm in unexplained syncope.
A total of 38 patients with syncope in whom a cause was not assigned or suggested by the initial history, physical examination and electrocardiography (ECG) were studied. Twenty-four patients underwent cardiac examination with Holter ECG, electrophysiologic testing with programmed ventricular stimulation (EPS) and/or coronary arteriography including ergonovine provocation (ergonovine CAG). The study with Holter ECG, EPS and ergonovine CAG yielded a presumptive diagnosis in 36 patients (36/38 = 95%), 11 with vasopastic angina, 7 with ventricular tachycardia, 4 with ischemic heart disease, 9 with sick sinus syndrome (SSS), 1 with drug induced SSS, 3 with A-V block, 1 with supraventricular tachycardia, 1 with hypertrophic cardiomyopathy, 1 with aortic valve stenosis and 1 with carotid sinus syndrome (included are 1 patient with ventricular tachycardia+ischemic heart disease, 1 with SSS+vasopastic angina and 1 with ventricular tachycardia+vasospastic angina). Therapy based on these findings provided complete symptomatic relief in all patients during a mean follow up of 25 +/- 10 months (range 5-45 months). In conclusion, EPS and ergonovine CAG are useful in the diagnosis and therapy of unexplained syncope.
Watanabe
K
K
Division of Cardiology, Tsubame Rosai Hospital, Niigata, Japan.
Inomata
T
T
Miyakita
Y
Y
Takahashi
M
M
Suzuki
T
T
Koyama
S
S
Ohshima
M
M
Suzuki
K
K
Masani
F
F
Aizawa
Y
Y
D006328:Cardiac Catheterization; D002304:Cardiac Pacing, Artificial; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000139:chemically induced* / Q000175:diagnosis; D004562:Electrocardiography; D004874:Ergonovine; D005260:Female; D006327:Heart Block / Q000175:diagnosis; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis; D012804:Sick Sinus Syndrome / Q000175:diagnosis; D013575:Syncope / Q000209:etiology*; D017180:Tachycardia, Ventricular / Q000175:diagnosis
D004874:Ergonovine