title: Successful treatment of refractory vasospastic angina with corticosteroids: coronary arterial hyperactivity caused by local inflammation?
abstract: BACKGROUND
  Although vasospastic angina usually responds well to treatment with calcium antagonists and/or nitrates, there have been anecdotal case reports of refractory vasospastic angina resistant to intensive treatment with high doses of calcium antagonists and nitrates.
  
  
  RESULTS
  Four patients with vasospastic angina, which was refractory to intensive treatment with high doses of calcium antagonists and nitrates, were completely controlled after administration of corticosteroids. Although none of the 4 patients showed eosinophilia, all had bronchial asthma or chronic thyroiditis, and in 2 cases, the activity of vasospastic angina corresponded with that of bronchial asthma.
  
  
  CONCLUSIONS
  These findings suggest that in these patients, coronary spasm may have been induced by arterial hyperreactivity because of local inflammation in the coronary arterial wall and that the corticosteroids suppressed the arterial hyperreactivity by alleviating the inflammation. Corticosteroids may be considered as a treatment choice for patients with refractory vasospastic angina, particularly when the patient has an allergic tendency, such as bronchial asthma.
authors.affiliation: Division of Cardiology, National Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Takagi
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Goto
authors.forename: Eiki
authors.initials: E
authors.lastname: Hirose
authors.forename: Masahiro
authors.initials: M
authors.lastname: Terashima
authors.forename: Satoru
authors.initials: S
authors.lastname: Sakuragi
authors.forename: Shoji
authors.initials: S
authors.lastname: Suzuki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Tsutsumi
authors.forename: Shunichi
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nonogi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000787:Angina Pectoris / Q000188:drug therapy* / Q000209:etiology; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001249:Asthma / Q000150:complications; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology; D003329:Coronary Vasospasm / Q000188:drug therapy*; D003331:Coronary Vessels / Q000187:drug effects / Q000503:physiopathology*; D004562:Electrocardiography; D004802:Eosinophilia / Q000150:complications; D005260:Female; D006801:Humans; D007249:Inflammation / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009566:Nitrates / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use*; D013966:Thyroiditis / Q000150:complications
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D002121:Calcium Channel Blockers; D009566:Nitrates; D011239:Prednisolone