Severe coronary artery spasm can be associated with hyperthyroidism.
BACKGROUND
Coronary artery spasm is not infrequently seen in Korea. Most of the patients with coronary spasm show a focal spasm in coronary angiography. However, the cause of the disease is not well known. There have been a few anecdotal case reports of coronary artery spasm associated with hyperthyroidism, but there has not been a report concerning a large series of such patients. Over a period of 5 years and 8 months, we experienced eight patients having the diffuse or severe type of coronary artery spasm in association with hyperthyroidism.


METHODS
We investigated the characteristics of the patients with coronary artery spasm, which was diagnosed by coronary angiography or by provocation with an intracoronary injection of acetylcholine or ergonovine. The demographic data, coronary angiographic findings, thyroid function test results, and the follow-up clinical data of the eight patients having coronary artery spasm associated with hyperthyroidism were analyzed.


RESULTS
All eight patients had Graves' disease. In six patients, the coronary arterial vasoconstriction developed during the coronary angiography without an injection of ergonovine. In three patients, the left main stem coronary artery was involved in the spasm. Among these eight patients, five were female, and all of these female patients were < or = 51 years old. All of the patients were treated with anti-thyroid medications, calcium channel blockers, and long-acting nitroglycerines; they all remained free of chest pain during the median follow-up period of 5 years.


CONCLUSIONS
A severe form of coronary artery spasm could be associated with hyperthyroidism. A high level of suspicion and the thyroid function study should be mandatory for patients with coronary artery spasm, especially for the young female patients.
Choi
Yoon-Ho
YH
Division of Cardiology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
Chung
Jae Hoon
JH
Bae
Sung Won
SW
Lee
Won-Ha
WH
Jeong
Euy-Myoung
EM
Kang
Min Gyung
MG
Kim
Byung Jin
BJ
Kim
Kwang-Won
KW
Park
Jeong Euy
JE
D000789:Angina, Unstable / Q000150:complications / Q000188:drug therapy; D013956:Antithyroid Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy; D003329:Coronary Vasospasm / Q000150:complications* / Q000188:drug therapy; D003331:Coronary Vessels / Q000503:physiopathology; D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use; D014661:Vasoconstriction / Q000502:physiology; D014665:Vasodilator Agents / Q000627:therapeutic use
D013956:Antithyroid Agents; D002121:Calcium Channel Blockers; D014665:Vasodilator Agents; D005996:Nitroglycerin