cardiovascular-agents and Angina-Pectoris--Variant

Topics: Angina Pectoris; Angina Pectoris, Variant; Cardiovascular Agents; Clinical Enzyme Tests; Coronary Angiography; Coronary Artery Bypass; Coronary Disease; Electrocardiography; Humans; Myocardial Infarction; Myocardial Revascularization; Prognosis

Topics: Angina Pectoris, Variant; Cardiovascular Agents; Clinical Trials as Topic; Electrocardiography; Epoprostenol; Humans; Iloprost; Infusions, Parenteral; Male; Middle Aged

Topics: Adrenergic beta-Antagonists; Angina Pectoris, Variant; Anti-Inflammatory Agents; Cardiovascular Agents; Coronary Angiography; Drug Therapy, Combination; Electrocardiography; Female; Fludrocortisone; Humans; Ivabradine; Middle Aged; Postural Orthostatic Tachycardia Syndrome; Propranolol; Tilt-Table Test

Topics: Angina Pectoris, Variant; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Angiography; Coronary Stenosis; Coronary Vasospasm; Drug-Eluting Stents; Everolimus; Humans; Male; Middle Aged; Prosthesis Design; Sirolimus; Time Factors; Treatment Outcome; Vasodilator Agents

Topics: Aged; Angina Pectoris, Variant; Cardiovascular Agents; Coronary Angiography; Death, Sudden, Cardiac; Electrocardiography, Ambulatory; Humans; Male; Methylergonovine; Predictive Value of Tests; Resuscitation; Telemetry; Time Factors; Treatment Outcome

Topics: Administration, Cutaneous; Administration, Oral; Angina Pectoris, Variant; Aspirin; Cardiovascular Agents; Chest Pain; Coronary Angiography; Coronary Vasospasm; Diltiazem; Drug Therapy, Combination; Electrocardiography; Follow-Up Studies; Humans; Male; Middle Aged; Nitrates; Platelet Aggregation Inhibitors; Time Factors

We present a case of a 49-year-old male with myocardial infarction in a course of variant angina. He was treated successfully with streptokinase, calcium antagonist and nitrates. Coronary angiography showed spasm of the left coronary artery, proximal spasm of the right coronary artery and myocardial bridging of the left anterior descending artery. He has been stable and symptom-free on a treatment with long acting calcium antagonist, nitrates and statin for 3-years.

Topics: Angina Pectoris, Variant; Cardiovascular Agents; Electrocardiography; Humans; Male; Middle Aged; Myocardial Infarction

We present three patients with variant angina pectoris and episodes of cardiac arrest. All of them had typical clinical symptoms, ST-segment changes in electrocardiogram, and coronary artery spasm confirmed by arteriography. They were treated with high doses of calcium antagonists and nitrates. An automatic cardioverter-defibrillator was implanted in the patient who developed ventricular fibrillation despite therapy with calcium antagonists. In another patient a DDD pacemaker was implanted because of high-degree atrioventricular block.

Topics: Amiodarone; Angina Pectoris, Variant; Anti-Arrhythmia Agents; Aspirin; Calcium Channel Blockers; Cardiovascular Agents; Coronary Angiography; Diltiazem; Electrocardiography; Female; Follow-Up Studies; Heart Arrest; Heart Block; Humans; Male; Middle Aged; Nitrates; Nitroglycerin; Pacemaker, Artificial; Platelet Aggregation Inhibitors; Spasm; Time Factors; Vasodilator Agents; Ventricular Fibrillation

Coronary artery spasm has been shown to play an important role in the pathogenesis of not only variant angina but also various arrhythmias. We present a case report of coronary vasospasm-induced arrhythmia and review the prevalence, mechanism, prognosis and management of this problem.

Topics: Aged; Angina Pectoris, Variant; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Vasospasm; Female; Humans; Prognosis; Stents; Tachycardia, Ventricular

Activated mast cells are present in human coronary atheromas, as well as in the adventitia of patients with variant angina, and may play an important role in plaque rupture and coronary vasomotion. To assess whether or not activation of mast cells is a primary event, we measured serum levels of tryptase, a specific marker of mast cell activation, in 8 patients with unstable angina during a spontaneous ischemic episode (Group 1) and in 5 patients with variant angina (Group 2) during ergonovine-induced coronary spasm. Blood samples were collected as soon as possible after the onset of pain and ECG changes (0 min), and after 5, 15 and 60 min. Tryptase levels in Group 1 were 0.13 U/l (range 0.017-0.44) at the onset of pain and significantly raised to 0.75 U/l (range 0.05-2.49) at 5 min, decreasing to 0.076 U/l (range 0.018-0.16) at 15 min and to 0.085 U/l (range 0.01-0.25) at 60 min (p = 0.035). Conversely, tryptase levels in Group 2 were 0.09 U/l (range 0.07-0.13) at 0 min, 0.11 U/l (range 0.07-0.22) at 5 min, 0.10 U/l (range 0.07-0.18) at 15 min, 0.11 U/l (range 0.07-0.17) at 60 min (NS). In conclusion, tryptase levels raise during spontaneous ischemic episodes in unstable angina, but not after ergonovine-provoked ischemia in variant angina, suggesting that a primary, yet unknown stimulus, may activate mast cells during some ischemic episodes in unstable angina.

Topics: Aged; Angina Pectoris, Variant; Angina, Unstable; Cardiovascular Agents; Chymases; Clinical Enzyme Tests; Ergonovine; Female; Humans; Inflammation Mediators; Male; Middle Aged; Myocardial Ischemia; Radioimmunoassay; Serine Endopeptidases; Time Factors; Tryptases

Chest pain in patients with hypertrophic cardiomyopathy seems to be caused by relative myocardial ischemia due to the left ventricular outflow pressure gradient and myocardial hypertrophy. However, in 2 cases of hypertrophic cardiomyopathy chest pain was associated with coronary vasospasm. Thus, chest pain in these cases was decreased not by a beta-blocker but by isosorbide dinitrate and a calcium antagonist. Because beta-blockers are commonly used for hypertrophic obstructive cardiomyopathy and chest pain may be aggravated by beta-blockers in patients with coronary vasospasm, a combination of beta-blocker, isosorbide dinitrate and calcium antagonist was necessary for this hypertrophic cardiomyopathy with variant angina.

Topics: Adrenergic beta-Antagonists; Aged; Angina Pectoris, Variant; Calcium Channel Blockers; Cardiomyopathy, Hypertrophic; Cardiovascular Agents; Coronary Vasospasm; Diltiazem; Drug Therapy, Combination; Electrocardiography; Humans; Isosorbide Dinitrate; Male; Middle Aged

Topics: Angina Pectoris; Angina Pectoris, Variant; Calcium; Cardiovascular Agents; Humans; Ion Channels; Muscle, Smooth, Vascular; Myocardial Contraction

Topics: Angina Pectoris, Variant; Calcium; Cardiovascular Agents; Diltiazem; Heart Diseases; Hemodynamics; Humans; Models, Biological; Muscle, Smooth, Vascular; Nifedipine; Vasoconstriction; Verapamil