Spontaneous multivessel coronary artery spasm diagnosed with intravascular ultrasound imaging:A case report

BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia.Although coronary artery spasm has been known for a long time,its mechanism has not yet been identified.Many clinicians,especially young clinicians pay less attention to coronary artery spasm,which may lead to some patients not being appropriately diagnosed and treated in time.We report a patient with spontaneous multivessel coronary artery spasm for more than 30 years diagnosed with intravascular ultrasound(IVUS)imaging.CASE SUMMARY A 66-year-old Chinese male patient had chest squeezing at rest for more than 30 years.He had a history of cigarette smoking for more than 40 years and hypertension for 10 years.Before presenting at our institution,the patient had undergone coronary angiography 4 times and percutaneous transluminal coronary angioplasty procedures twice at other hospitals without a diagnosis of coronary artery spasm.However,his chest symptoms worsened.Spontaneous multivessel coronary artery spasm occurred during IVUS without provocation testing,and the IVUS image was recorded.Thus,the diagnosis of multifocal spontaneous coronary artery spasm was confirmed.The patient was placed on oral diltiazem,isosorbide mononitrate,and nicorandil to suppress coronary artery spasms.All medications were given at the maximum dosages tolerated by the patient.He was discharged after 5 d without complications.During the six-month follow-up period,the patient was symptom-free.CONCLUSION Coronary artery spasm is still prevalent in Eastern countries.It is essential for clinicians to be aware of coronary artery spasm,which may be hard to detect and can be lethal,in order to diagnose and treat patients appropriately.

Lack of Association between Genetic Polymorphisms Affecting Autonomic Activity and Coronary Artery Spasm

Coronary artery spasm （CAS） is one of the leading pathological causes of a wide spectrum of ischemic heart diseases, ranging from variant angina pectoris to acute myocardial infarction and even sudden cardiac death[1]. Furthermore, Pierron et al. concluded that CAS of angiographically normal or sub-normal arteries is responsible for death or myocardial infarction in 11.6% of all cases. Oddly, the incidence of CAS is remarkably higher in Asians than in Caucasians[3], suggesting genetic involvement In its pathogenesis.

Spontaneous diffuse vasospasm simultaneously found at left main trunk, left anterior descending, left circumflex and right coronary arteries

Coronary artery spasm （CAS） is found not only in Asian but also in white patients. CAS can lead to angina pecto- ris, myocardial infarction, ventricular arrhythmias and sud- den cardiac death. But CAS diagnosis is not necessarily easy, and it also remains highly challenging to therapy and prevention. We present a spontaneous extensive-CAS case with typical clinical features of acute myocardial infarction, despite the regular vasodilator treatment.

In-Hospital Cardiac Arrest after Emotional Stress in a Patient Hospitalized with Gastrointestinal Symptoms and Chronic Anxiety Disorder

Background:We report an acute emotional stress-induced in-hospital cardiac arrest in a patient admitted with gas-trointestinal symptoms after experiencing chronic anxiety disorder.Case Presentation:The patient was admitted to the Second Xiangya Hospital,Central South University,with gastrointestinal symptoms and chronic anxiety disorder,and experienced cardiac arrest during hospitalization after acute emotional stress.Malignant ventricular tachycardia and cardiogenic shock were evidenced in this patient after the acute emotional stress.Severe and extensive coronary spasm was confi rmed by emergency coronary angiography,and coronary spasm was relieved by intracoronary injection of nitroglycerin.The patient recovered from myocardial infarction with nonobstructive coronary arteries.However,the patient developed acute kidney dysfunction and severe pulmonary infection and eventually died of respiratory circulatory failure on the ninth day after the successful rescue.Conclusions:Acute emotional stress on top of chronic anxiety disorder in patients hospitalized for noncardiovascu-lar reasons might lead to the development of life-threatening cardiovascular diseases,including coronary artery spasm and myocardial infarction with nonobstructive coronary arteries.Psychological management is of importance to im-prove the outcome of these patients.

Incidence and predictors of radial artery spasm during transradial coronary angiography and intervention

Background Radial artery spasm （RAS） is the most common complication in transradial coronary angiography and intervention. In this study, we designed to investigate the incidence of RAS during transradial procedures in Chinese, find out the independent predictors through multiple regression, and analyze the clinical effect of RAS during follow-up. Methods Patients arranged to receive transradial coronary angiography and intervention were consecutively enrolled. The incidence of RAS was recorded. Univariate analysis was performed to find out the influence factors of RAS, and logistic regression analysis was performed to find out the independent predictors of RAS. The patients were asked to return 1 month later for the assessment of the radial access.Results The incidence of RAS was 7.8% （112/1427） in all the patients received transradial procedure. Univariate analysis indicates that young （P=0.038）, female （P=0.026）, small diameter of radial artery （P 〈0.001）, diabetes （P=0.026）, smoking （P=0.019）, moderate or severe pain during radial artery cannulation （P〈0.001）, unsuccessful access at first attempt （P=0.002）, big sheath （P=0.004）, number of catheters （〉3） （P=0.048）, rapid baseline heart rate （P=0.032） and long operation time （P=0.021） were associated with RAS. Logistic regression showed that female （OR=1.745, 95% CI： 1.148-3.846, P=0.024）, small radial artery diameter （OR=4.028, 95%CI： 1.264-12.196, P=0.008）, diabetes （OR= 2.148, 95%CI： 1.579-7.458, P=0.019） and unsuccessful access at first attempt （OR=1.468, 95%CI： 1.212-2.591, P=0.032） were independent predictors of RAS. Follow-up at （28±7） days after the procedure showed that, compared with non-spasm patients, the RAS patients had higher portion of pain （11.8% vs. 6.2%, P=0.043）. The occurrences of hematoma （7.3% vs. 5.6%, P=0.518） and radial artery occlusion （3.6% vs. 2.6%, P=0.534） were similar. Conclusions The incidence of RAS during transradial coronary procedure was 7.8%. Logistic regression analysis showed that female, small radial artery diameter, diabetes and unsuccessful access at first attempt were the independent predictors of RAS.

Recurrent Multivessel Coronary Artery Spasm Presented as Myocardial Infarction

Coronary artery spasm is typically a transient and marked narrowing of a single coronary artery lumen that induces myocardial ischemia.In general,patients with coronary spastic angina have a good prognosis.Herein,we described a case of recurrent diffuse multivessel coronary artery spasm presented as myocardial infarction,which was a very rare form of coronary heart disease.Although several similar ones have been reported worldwide,this is the first case rechecked by coronary angiography （CAG） in the follow-up period.