An uncommon case of variant angina.
This case report describes a 48-year-old woman patient with variant angina who died because of severe myocardial ischemia and cardiogenic shock, in spite of chronic therapy with nitrates and calcium-antagonists and acute intravenous administration of nitrates, calcium-antagonists and tissue-type plasminogen activator. Her Holter monitoring showed a reduction of time domain measures of heart rate variability. The hemodynamic study exhibited a normal ventriculography and angiographically normal epicardial coronary arteries. The provocative testing, performed (during intravenous therapy with nitrates and diltiazem) by intracoronary injection of progressively increasing doses of ergonovine, induced only a mild vasoconstriction of proximal left anterior descending artery, without symptoms or ST-T segment changes. This case reminds us that variant angina can be a lethal disease, confirms that a negative result of intracoronary ergonovine testing performed during intravenous therapy with nitrates and calcium-antagonists does not assure the prevention of new episodes during chronic oral therapy with the same drugs, suggests a possible prognostic value of the reduction of heart rate variability indexes and shows an unusual response to nitrate administration.
Stazi
F
F
Divisione di Cardiologia, IRCCS H San Raffaele, Milano.
Meloni
C
C
Ballarotto
C
C
D000788:Angina Pectoris, Variant / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use; D017023:Coronary Angiography; D004110:Diltiazem / Q000008:administration & dosage / Q000627:therapeutic use; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D004874:Ergonovine / Q000008:administration & dosage; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology; D009566:Nitrates / Q000008:administration & dosage / Q000627:therapeutic use; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
D002121:Calcium Channel Blockers; D009566:Nitrates; D014665:Vasodilator Agents; D010959:Tissue Plasminogen Activator; D004110:Diltiazem; D004874:Ergonovine