title: Does a negative ergonovine provocation test truly predict freedom from variant angina?
abstract: Ergonovine provocation test is known to be very sensitive for diagnosing variant angina. The patient described in this study initially presented with atypical chest pain and underwent coronary angiography and ergonovine provocation tests, which were negative. The patient was subsequently prescribed a proton pump inhibitor and prokinetics for pain relief, but then presented with acute myocardial infarction and cardiogenic shock due to coronary artery vasospasm 5 years later. This case suggests that ergonovine provocation test generates false negative results, which can lead to unwanted outcomes. Even with a negative ergonovine provocation test, prescription of calcium channel blockers or nitrates should be considered in patients with a clinical history suggestive of variant angina.
authors.affiliation: Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Yun Gi
authors.initials: YG
authors.lastname: Kim
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Won-Suk
authors.initials: WS
authors.lastname: Choi
authors.forename: Moon-Sun
authors.initials: MS
authors.lastname: Im
authors.forename: Chang-Hwan
authors.initials: CH
authors.lastname: Yoon
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Suh
authors.forename: Dong-Ju
authors.initials: DJ
authors.lastname: Choi
keywords: Angina pectoris, variant; Coronary vasospasm; Ergonovine