title: Microvascular angina accompanied by epicardial coronary artery spasm.
abstract: A case of microvascular angina accompanied by coronary artery spasm is described. A 54-year-old woman had anginal pain at rest and during exercise. Both exercise testing and rapid atrial pacing caused significant ST depression in the inferior and all precordial leads. Exercise thallium myocardial scintigraphy was negative despite similar ST depressions. Coronary angiography revealed insignificant stenoses of the left anterior descending coronary artery after the injection of nitrate. Intracoronary acetylcholine provoked diffuse spasm of the artery with concurrent myocardial lactate production. Coronary flow reserve assessed with papaverine was 2.75. The combined use of amlodipine and high-dose nicorandil was effective for the treatment of angina.
authors.affiliation: Division of Cardiology, Chitose City General Hospital, Chitose, Hokkaido .
authors.forename: Masashi
authors.initials: M
authors.lastname: Horimoto
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sakuragi
authors.forename: Takashi
authors.initials: T
authors.lastname: Takenaka
authors.forename: Hitoki
authors.initials: H
authors.lastname: Inoue
authors.forename: Keiichi
authors.initials: K
authors.lastname: Igarashi
mesh_terms: D000787:Angina Pectoris / Q000150:complications*; D003329:Coronary Vasospasm / Q000150:complications*; D005260:Female; D006801:Humans; D008833:Microcirculation; D008875:Middle Aged; D010496:Pericardium