Coronary spasm: Prinzmetal's variant angina vs. catheter-induced spasm; refractory spasm vs. fixed stenosis

AJR. American Journal of Roentgenology
A C FriedmanT Nivatpumin

Abstract

An analysis of 2,394 selective coronary angiograms yielded 23 examples of coronary artery spasm. Of these, nine occurred in patients with Prinzmetal's variant angina and 14 were instances of catheter-induced spasm. Angiographic criteria can distinguish between the spasm of variant angina and catheter-induced spasm. The latter is usually asymptomatic, almost invariably in the right coronary artery, at the catheter tip, smooth, concentric, and less than 2 mm long. The former can occur in any coronary artery at a distance of 1--4 cm from the catheter tip, is usually irregular and eccentric, and is associated with angina, ST segment elevation, hypotension, and dysrhythmia. Response to nitroglycerin is often, but not always, complete in both. Stenoses that seem to be fixed in patients with Prinzmetal's angina should be suspected to be spasm even if unresponsive to nitroglycerin, especially when the rest of the vessel is normal. Additional pharmacologic manipulation and even recatheterization may be necessary to prove the dynamic nature of the lesion and avoid unnecessary surgery.

Citations

Jun 1, 1996·International Journal of Cardiology·W L NgY T Lim
Feb 13, 2004·Progress in Cardiovascular Diseases·Srilakshmi Konidala, D D Gutterman
May 28, 2003·International Journal of Cardiology·Ramesh M GowdaTerrence J Sacchi
Oct 26, 2016·Journal of Cardiovascular and Thoracic Research·Mohammad Ali OstovanPooyan Dehghani
Jan 1, 1993·Circulation·W J ManningR R Edelman
Jun 1, 1997·Catheterization and Cardiovascular Diagnosis·R IliaA Battler
Aug 14, 2018·Internal Medicine·Shozo SuedaHiroaki Kohno

Related Concepts

Angina Pectoris
Angina Pectoris, Variant
Coronary Heart Disease
Differential Diagnosis
Ergotrate
Trinitrolong
Cardiac Catheterization Procedures
Metoxamine Wellcome
Generalized Spasms

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