title: Variant angina in moyamoya disease--a correlative etiology and different presentation: a case report.
abstract: BACKGROUND
  Moyamoya disease is characterized by progressive steno-occlusive changes of the distal internal carotid and developed collateral vasculature, so called 'moyamoya' vessels at the base of the brain. Variant angina is a rare occurrence in patients with moyamoya disease.
  
  
  METHODS
  Here we report the case of a 41-year-old Korean woman who developed chest pain after indirect revascularization surgery of moyamoya disease. A treadmill test and an exercise stress echocardiograph showed positive results, but there was no significant major coronary arteries stenosis. Suspicious of vasospasm, we conducted an ergonovine spasm stimulation test, which demonstrated tight stenosis of her proximal left anterior descending artery. At the site of spasm, intravascular ultrasound virtual histology showed intraluminal fibrous plaque.
  
  
  CONCLUSIONS
  Physicians who follow up patients with moyamoya disease would need to be aware of the possibility of cardiac ischemia as well as neurological manifestations.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Sejong General Hospital & Sejong Heart Institute, Hyohyunro 489 street, Bucheon, Kyunggi-do, Republic of Korea. gwangjense@gmail.com.
authors.forename: Woong
authors.initials: W
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Sejong General Hospital & Sejong Heart Institute, Hyohyunro 489 street, Bucheon, Kyunggi-do, Republic of Korea. dbskydueto@naver.com.
authors.forename: Yu Na
authors.initials: YN
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Sejong General Hospital & Sejong Heart Institute, Hyohyunro 489 street, Bucheon, Kyunggi-do, Republic of Korea. learnbyliving9@gmail.com.
authors.forename: Kyung-Hee
authors.initials: KH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000788:Angina Pectoris, Variant / Q000175:diagnosis* / Q000209:etiology; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D002637:Chest Pain / Q000209:etiology; D004874:Ergonovine; D005260:Female; D006801:Humans; D009072:Moyamoya Disease / Q000150:complications* / Q000601:surgery
chemical_list: D004874:Ergonovine