Spasm Provocation Tests under Medication May Help Decide on Medical or Mechanical Therapy in Patients with Aborted Sudden Cardiac Death due to Coronary Spasm

Internal Medicine
Shozo SuedaTakafumi Okura

Abstract

Objective The decision to perform medical or mechanical therapy in patients with aborted sudden cardiac death (ASCD) due to coronary spasm is controversial. The Japanese Circulation Society guidelines for the diagnosis and treatment of patients with coronary spastic angina mentioned that implantable cardioverter-defibrillator (ICD) is one option in patients with ASCD due to coronary spasm. We investigated the usefulness of spasm provocation tests under medications in five patients with ASCD due to coronary spasm. Methods We performed the spasm provocation tests under medications in five ASCD patients due to coronary spasm. Pharmacological spasm provocation tests, including five acetylcholine (ACh) tests, two ergonovine (ER) tests, and two ACh added after ER tests, were performed to estimate the effect of medications to suppressing the next fatal spasms. Results ACh tests under medications did not provoke spasm in one patient but did provoke in two patients. In the remaining two patients, neither the ACh test nor the ER test provoked spasm, but the ACh added after ER test induced a focal spasm in one coronary artery. We increased the medication dosage in four patients. An ICD was implanted in two patients, including one with ref...Continue Reading

References

Oct 1, 1988·Journal of the American College of Cardiology·K OkumuraK Matsuyama
Apr 10, 2012·International Journal of Cardiology·Chang-Myung OhBoyoung Joung
Nov 10, 2013·Journal of the American College of Cardiology·Melody ZayaC Noel Bairey Merz
Jan 1, 2014·Archives of Cardiovascular Diseases·Romain EschalierPascal Motreff
Apr 9, 2014·Archives of Cardiovascular Diseases·Romain EschalierPierre Bordachar
Oct 3, 2014·Circulation Journal : Official Journal of the Japanese Circulation Society·UNKNOWN JCS Joint Working Group
Aug 31, 2016·Circulation. Arrhythmia and Electrophysiology·Masayasu KomatsuHiroaki Shimokawa

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Citations

May 29, 2020·Internal Medicine·Teruhiko Imamura

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