A 43-year-old woman with recurrent atypical angina underwent invasive coronary angiography including intracoronary Doppler blood flow assessment and coronary spasm provocation testing.While obstructive epicardial dise...A 43-year-old woman with recurrent atypical angina underwent invasive coronary angiography including intracoronary Doppler blood flow assessment and coronary spasm provocation testing.While obstructive epicardial disease could be ruled-out angiographically,the patient experienced reproduction of her angina symptoms after intracoronary administration of acetylcholine(100μg)during spasm provocation testing.Simultaneously,the ECG showed new-onset ST-segment depression in the absence of epicardial spasm.In addition,coronary fl ow velocity was signifi cantly reduced after acetylcholine compared to the baseline condition.Following intracoronary administration of nitroglycerine(200μg),the patient’s symptoms as well as the ECG changes and coronary flow reduction were reversed.Considering the ongoing challenges in appropriate evaluation of the pathophysiological mechanisms of coronary microvascular dysfunction,simultaneous intracoronary Doppler flow measurement during spasm testing–as shown in this case–may provide objective evidence for microvascular spasm in addition to the standardized diagnostic criteria,especially if they are ambiguous.展开更多
Introduction and Patient Description,Assessment of patients with angina pectoris is a challenge for the clinical cardiologist.Myocardial ischemia and angina pectoris can be caused by various mechanisms,such as coronar...Introduction and Patient Description,Assessment of patients with angina pectoris is a challenge for the clinical cardiologist.Myocardial ischemia and angina pectoris can be caused by various mechanisms,such as coronary atherosclerosis,vasospasm,or coronary microvascular dysfunction[1].Moreover,these mechanisms may overlap in a given patient,making it difficult to determine the cause of angina.We report here the case of a 57-year-old female patient with a history of angina pectoris that started 3 months previously.Her symptoms occurred predominantly at rest but also with effort.The patient was an active smoker who smoked about 15 cigarettes per day(~20 packyears).Moreover,she had hypertension treated with enalapril.Her LDL level was 75 mg/dl without any cholesterol-lowering therapy.She was sent for diagnostic coronary angiography for suspected stenosing coronary artery disease.展开更多
Introduction Myocardial ischemia and angina pectoris can be caused by various mechanisms such as coronary atherosclerosis,vasospasm or coronary microvascular dysfunction[1].We here report a case of a56-year-old female...Introduction Myocardial ischemia and angina pectoris can be caused by various mechanisms such as coronary atherosclerosis,vasospasm or coronary microvascular dysfunction[1].We here report a case of a56-year-old female patient with a history of previous percutaneous coronary interventions(PCI)who reported repetitive attacks of resting angina.Coronary risk factors included hypertension,hypercholesterolemia(LDL=97 mg/dL on atorvastatin),ex-smoker(ceased 2013),and a positive family history(fatal myocardial infarction in father aged52years and brother 59 years).展开更多
基金This work was funded by the Robert Bosch Stiftung,Stuttgart,Germany,and the Berthold Leibinger Stiftung,Ditzingen,Germany.
文摘A 43-year-old woman with recurrent atypical angina underwent invasive coronary angiography including intracoronary Doppler blood flow assessment and coronary spasm provocation testing.While obstructive epicardial disease could be ruled-out angiographically,the patient experienced reproduction of her angina symptoms after intracoronary administration of acetylcholine(100μg)during spasm provocation testing.Simultaneously,the ECG showed new-onset ST-segment depression in the absence of epicardial spasm.In addition,coronary fl ow velocity was signifi cantly reduced after acetylcholine compared to the baseline condition.Following intracoronary administration of nitroglycerine(200μg),the patient’s symptoms as well as the ECG changes and coronary flow reduction were reversed.Considering the ongoing challenges in appropriate evaluation of the pathophysiological mechanisms of coronary microvascular dysfunction,simultaneous intracoronary Doppler flow measurement during spasm testing–as shown in this case–may provide objective evidence for microvascular spasm in addition to the standardized diagnostic criteria,especially if they are ambiguous.
文摘Introduction and Patient Description,Assessment of patients with angina pectoris is a challenge for the clinical cardiologist.Myocardial ischemia and angina pectoris can be caused by various mechanisms,such as coronary atherosclerosis,vasospasm,or coronary microvascular dysfunction[1].Moreover,these mechanisms may overlap in a given patient,making it difficult to determine the cause of angina.We report here the case of a 57-year-old female patient with a history of angina pectoris that started 3 months previously.Her symptoms occurred predominantly at rest but also with effort.The patient was an active smoker who smoked about 15 cigarettes per day(~20 packyears).Moreover,she had hypertension treated with enalapril.Her LDL level was 75 mg/dl without any cholesterol-lowering therapy.She was sent for diagnostic coronary angiography for suspected stenosing coronary artery disease.
文摘Introduction Myocardial ischemia and angina pectoris can be caused by various mechanisms such as coronary atherosclerosis,vasospasm or coronary microvascular dysfunction[1].We here report a case of a56-year-old female patient with a history of previous percutaneous coronary interventions(PCI)who reported repetitive attacks of resting angina.Coronary risk factors included hypertension,hypercholesterolemia(LDL=97 mg/dL on atorvastatin),ex-smoker(ceased 2013),and a positive family history(fatal myocardial infarction in father aged52years and brother 59 years).
