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Hyperventilation echocardiography in spastic angina pectoris diagnosing


Authors: M. Kaletová;  D. Marek;  E. Sovová;  I. Mejtská;  M. Táborský
Authors‘ workplace: I. interní klinika – kardiologická Lékařské fakulty UP a FN Olomouc, přednosta doc. MUDr. Miloš Táborský, CSc., FESC, MBA
Published in: Vnitř Lék 2012; 58(9): 691-696
Category: Case Reports

Overview

Hyperventilation echocardiography is an established diagnostic test in patients with suspected variant angina pectoris. It has got sufficient sensitivity (60–80%) and specificity (85–100%). Positive hyperventilation test is rarely found, which relates to low prevalence of variant angina. The diagnostic yield of the test depends on the population selected for testing: positive result can be expected in patients with a history of typical burning chest pain, ST segment elevation/depression and/or inversions of U wave during the chest pain episode, arrhythmias related to the chest pain, coronary artery stenosis less than 50% of artery diameter, multi-vessel disease, high activity of illness at the time of hyperventilation test. We present a case of 37 years old man with typical angina pectoris at rest and non-Q myocardial infarction, in whom the coronary angiography was negative. Variant angina pectoris was diagnosed by hyperventilation echocardiography. The ECG tracings showing typical ischemic patterns during the hyperventilation test are included.

Key words:
spastic angina – variant angina – Prinzmetal’s angina – hyperventilation echocardiography test – non-Q myocardial infarction


Sources

1. Fedorco M, Skála T, Václavik J et al. Variantní (Prinzmetalova) angina pectoris jako méně častá příčina kardiální synkopy. Cor Vasa 2008; 50: 348–351.

2. Skála T, Hutyra M, Galuszka J et al. Maligní arytmie u pacienta s variantní (Prinzmetalovou) anginou pectoris. Vnitř Lék 2007; 53: 724–728.

3. Kawano H, Ogawa H. Endotelial function and coronary spastic angina. Intern Med 2005; 44: 91–99.

4. Yasue H, Nakaqawa H, Itoh T et al. Coronary artery spasm – clinical features, diagnosis, pathogenesis and treatment. J Cardiol 2008; 51: 2–17.

5. Yasue H, Omote S, Takizawa A et al. Coronary arterial spasm in ischemic heart disease and its pathogenesis. A review. Circ Res 1983; 52 (2 Pt 2): I147–I152.

6. Miwa K, Fujita M, Sasayama S. Recent insight into mechanisms, predisposing factors and racial differences of coronary vasospasm. Heart Vessels 2005; 20: 1–7.

7. Onaka H, Hirota Y, Shimada S et al. Clinical observation of spontaneous anginal attacks and multivessel spasm in variant angina with normal coronary arteries: evaluation by 24-hour 12-lead electrocardiography with computer analysis. J Am Coll Cardiol 1996; 27: 38–44.

8. Bělohlávek J, Horák J, Humhal J et al. Koronární spasmy. Cor Vasa 2009; 51: 218–219.

9. Schroeder JS, Bolen JL, Quint RA et al. Provocation of coronary spasm with ergonovine maleate. New test with results in 57 patients undergoing coronary arteriography. Am J Cardiol 1977; 40: 487–491.

10. Siegel W. The first provocative test for coronary artery spasm at the Cleveland Clinic. Am J Cardiol 2010; 105: 1198–1199.

11. Miwa K, Fujita M, Ejiri M et al. Usefulness of intracoronary injection of acetylcholine as a provocative test for coronary artery spasm in patients with vasospastic angina. Hearth Vessels 1991; 6: 96–101.

12. Sovová E, Lukl J, Číhalík Č. Vasospastická angina pectoris – patogeneza, diagnostika a léčba. Vnitř Lék 2005; 51: 548–554.

13. Sueda S, Oshita A, Izoe Y et al. Potential risk caused by the lack of recognition of coronary spasm: analysis of the coronary spasm questionnaire in Japan. J Cardiol 2007; 49: 83–90.

14. Sueda S, Hashimoto H, Ochi N et al. New protocol to detect coronary spastic angina without fixed stenosis. Jpn Heart J 2002; 43: 307–317.

15. Sueda S, Fukuda H, Watanabe K et al. Usefulness of accelerated exercise following mild hyperventilation for the induction of coronary artery spasm: comparison with an acetylcholine Test. Chest 2001; 119: 155–162.

16. Morales MA, Reisenhofer B, Rovai D et al. Hyperventilation-echocardiography test for the diagnosis of myocardial ischaemia at rest. Eur Hearth J 1993; 14: 1088–1093.

17. Rasmussen K, Henningsen P. Provocative testing with prolonged hyperventilation and ergometrine in patients suspected of coronary artery spasm: a comparative study. Int J Cardiol 1987; 15: 151–163.

18. Waters DD, Crean PA, Roy D et al. Problems related to the detection of myocardial ischemia caused by coronary vasospasm. Can J Cardiol 1986; Suppl A: 173A–179A.

19. Previtali M, Ardissino D, Barberis P et al. Hyperventilation and ergonovine tests in Prinzmetal’s variant angina pectoris in men. Am J Cardiol 1989; 63: 17–20.

20. Nakao K, Ohgushi M, Yoshimura M et al. Hyperventilation as a specific test for diagnosis of coronary artery spasm. Am J Cardiol 1997; 80: 545–549.

21. Cannon P, Braunwald E. Unstable Angina and Non-ST Elevation Myocardial Infarction. In: Zipes DP, Libby P, Braunwald E et al (eds). Braun­wald’s heart disease. A textbook of cardio­vascular medicine. Philadelphia: Elsevier Saunders 2005: 1243–1279.

22. Khatri S, Webb JG, Carere RG et al. Stenting for coronary artery spasm. Catheter Cardiovasc Interv 2002; 56: 16–20.

23. Jeong MH, Park JC, Rhew JY et al. Successful management of intractable coronary spasm with a coronary stent. Jpn Circ J 2000; 64: 897–900.

24. Yasue H, Takizawa A, Nagao M et al. Long--term prognosis for patient with variant angina and influential factors. Circulation 1988; 78: 1–9.

25. Bory M, Pierron F, Panagides D et al. Coronary artery spasm in patients with normal or near normal coronary arteries. Long-term follow-up of 277 patients. Eur Heart J 1996; 17: 1015–1021.

26. Shimokawa H, Nagasawa K, Irie T et al. Clinical characteristics and long-term prognosis of patients with variant angina. A comparative study between western and Japanese popula­tions. Int J Cardiol 1988; 18: 331–349.

27. Hradec J, Bultas J, Želízko M. Stabilní angina pectoris. Doporučený diagnostický a léčebný postup České kardiologické společnosti. Cor Vas 2010; 52: 543–561.

28. Harding MB, Leithe ME, Mark DB et al. Ergonovin maleat testing during cardiac catheterization: a 10-year perspective in 3,447 patients without significant coronary arterydisease or Prinzmetal’s variant angina. J Am Coll Cardiol 1993; 21: 848.

29. Kimball BP, LiPreti V, Aldridge HE. Quantitative arteriographic responses to ergonovine provocation in subjects with atypical chest pain. Am J Cardiol 1989; 64: 778–782.

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Diabetology Endocrinology Internal medicine
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