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 clinici...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.展开更多
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 n...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.展开更多
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[...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.展开更多
The article is dedicated to the management of internal mammary artery spasm intra- and postoperatively based on the accumulated evidence in the literature. It provides a stepwise decision algorithm for safely resolvin...The article is dedicated to the management of internal mammary artery spasm intra- and postoperatively based on the accumulated evidence in the literature. It provides a stepwise decision algorithm for safely resolving the spasm and prevention of relapse.展开更多
Objective Coronary artery disease(CAD) is a global problem.Every year, there was millions of patients suffered from CAD. With the fast development of coronary revascularization therapy, the mortality has decreased dra...Objective Coronary artery disease(CAD) is a global problem.Every year, there was millions of patients suffered from CAD. With the fast development of coronary revascularization therapy, the mortality has decreased dramatically, while there still some forts needed to be conquered, such as multi-vessel coronary artery disease(MVD).展开更多
We presented a case of anomalous single-coronary artery detected incidentally during routine coronary angiography. A 32-year-old male Chinese patient presented with recurrent pre-syncope and six episodes of syncope. C...We presented a case of anomalous single-coronary artery detected incidentally during routine coronary angiography. A 32-year-old male Chinese patient presented with recurrent pre-syncope and six episodes of syncope. Coronary angiography and coronary-computed tomography (CT)-angiography performed by a dual-source computed tomography (DSCT) revealed that the patient had a single large right coronary artery. A moderately large branch originated from the proximal part of the single right coronary artery and extended to the left,passing the anterior to the pulmonary artery,and divided into the anterior descending artery branch and circumflex branch at the base of the left auricular appendage. The episodes of the syncope were suspected to be caused by coronary arterial spasm,so this patient was on a regimen of 30 mg of diltiazem every 6 h and had no recurrence of syncope during follow-up.展开更多
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...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.展开更多
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 d...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.展开更多
文摘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.
文摘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.
基金supported by fund from Guangdong Natural Science Foundation (No. 9251001002000002)
文摘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.
文摘The article is dedicated to the management of internal mammary artery spasm intra- and postoperatively based on the accumulated evidence in the literature. It provides a stepwise decision algorithm for safely resolving the spasm and prevention of relapse.
文摘Objective Coronary artery disease(CAD) is a global problem.Every year, there was millions of patients suffered from CAD. With the fast development of coronary revascularization therapy, the mortality has decreased dramatically, while there still some forts needed to be conquered, such as multi-vessel coronary artery disease(MVD).
基金Project (Nos. 30400173 and 30971257) supported by the National Natural Science Foundation of China
文摘We presented a case of anomalous single-coronary artery detected incidentally during routine coronary angiography. A 32-year-old male Chinese patient presented with recurrent pre-syncope and six episodes of syncope. Coronary angiography and coronary-computed tomography (CT)-angiography performed by a dual-source computed tomography (DSCT) revealed that the patient had a single large right coronary artery. A moderately large branch originated from the proximal part of the single right coronary artery and extended to the left,passing the anterior to the pulmonary artery,and divided into the anterior descending artery branch and circumflex branch at the base of the left auricular appendage. The episodes of the syncope were suspected to be caused by coronary arterial spasm,so this patient was on a regimen of 30 mg of diltiazem every 6 h and had no recurrence of syncope during follow-up.
文摘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.
文摘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.
