Alternate coronary artery spasm with ST-segment "seesaw" phenomenon in variant angina.
Five patients with variant angina showed alternating ST-segment elevation and contralateral ST-segment depression between the precordial and inferior leads in electrocardiographic recordings made during sequential anginal attacks. This electrocardiographic "seesaw" phenomenon was observed during ergonovine-induced attacks in 3 cases and during spontaneous attacks in 1 case. Another patient showed ST-segment elevation in a spontaneous attack and in other leads during hyperventilation. In all cases, the first attack was accompanied by ST-segment elevation in the inferior leads. Coronary arteriography demonstrated that in all cases, coronary arterial spasm occurred during the attacks in both coronary arterial systems. Significant organic coronary arterial stenoses (> 50%) were found in both the left anterior descending branch and the right coronary artery in 2 patients. The remaining 3 patients showed no significant organic stenoses in any major coronary artery. However, pre-anginal coronary arteriography demonstrated that 13 of the 15 major coronary arteries, including all 9 of the major coronary arteries in the patients without significant stenoses, were already spastic. An exercise stress test performed in the morning induced attacks with chest pain and electrocardiographic ST-segment elevation in all 5 patients. The patients having an alternate ST-segment elevation in separate leads had vasospastic tendencies in both coronary arterial systems.
Miwa
K
K
Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Japan.
Fujita
M
M
D000328:Adult; D000368:Aged; D000788:Angina Pectoris, Variant / Q000503:physiopathology* / Q000517:prevention & control; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000503:physiopathology*; D004110:Diltiazem / Q000627:therapeutic use; D004562:Electrocardiography; D004874:Ergonovine / Q000494:pharmacology; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000627:therapeutic use
D002121:Calcium Channel Blockers; D004110:Diltiazem; D009543:Nifedipine; D004874:Ergonovine