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Seok-Ran Yeom, Sung-Wook Park, Young-Dae Kim, Byung-Jae Ahn, Jin-Hee Ahn, Il-Jae Wang
Pneumothorax can cause a variety of electrocardiographic changes. ST segment elevation, which is mainly observed in myocardial infarction, can also be induced by pneumothorax. The mechanism is presumed to be a decrease in cardiac output, due to increased intra-thoracic pressure. We encountered a patient with ST segment elevation with minimal pneumothorax. Coronary angiography with ergonovine provocation test and echocardiogram had normal findings. The ST segment elevation was normalized by decreasing the amount of pneumothorax...
April 19, 2017: American Journal of Emergency Medicine
Min Gyu Kang, Kye-Hwan Kim, Jin-Sin Koh, Young-Hoon Jeong, Jin-Yong Hwang, Jeong Rang Park
Takotsubo cardiomyopathy (TCM) is a transient left ventricular dysfunction that typically occurs after emotional or physical stress. TCM has a benign prognosis and serious complications are uncommon. However, though very rarely reported, cardiac tamponade has occurred on some occasions. We hereby report the case of a 70-year-old woman who underwent coronary angiography with an ergonovine provocation test to evaluate recurrent chest pain and was readmitted 7 days later presenting with TCM, followed by left ventricular outflow tract obstruction and cardiac tamponade...
2017: Case Reports in Cardiology
Shozo Sueda, Hiroaki Kohno
BACKGROUND: We reported less provoked spasm in the left circumflex artery (LCX) by acetylcholine testing compared with the left anterior descending artery (LAD) and right coronary artery (RCA), so we investigated the clinical characteristics of provoked spasm in the LCX by ergonovine (ER) testing.Methods and Results:We retrospectively analyzed 1,185 consecutive cases of intracoronary ER testing during 25 years. Maximal ER dose was 64 μg into the left coronary artery (LCA) and 40 μg into the RCA...
March 23, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
Eun-Seok Shin, Ae-Young Her, Soe Hee Ann, Gillian Balbir Singh, Heeyoun Cho, Eui Cheol Jung, Eun Bo Shim, Bon-Kwon Koo, Takashi Akasaka
INTRODUCTION AND OBJECTIVES: Vasospastic angina (VSA) can result in endothelial damage and thrombus formation. The aim of this study was to evaluate the incidence of thrombus and plaque characteristics at coronary spasm segments compared with nonspasm segments by using optical coherence tomography (OCT) in patients with suspected VSA. METHODS: One hundred and eighty-three patients with suspected VSA were enrolled in this study. The ergonovine provocation test was performed in all patients for the diagnosis of VSA except in patients with spontaneous spasm...
December 7, 2016: Revista Española de Cardiología
Shozo Sueda, Hiroaki Kohno, Takaaki Ochi, Tadao Uraoka, Kensuke Tsunemitsu
The spasm provocation tests of ergonovine and acetylcholine have been employed in the cardiac catheterization laboratory. Ergonovine acts through the serotogenic receptors, while acetylcholine acts through the muscarinic cholinergic receptors. Different mediators may have the potential to cause different coronary responses. However, there are few reports concerning the coronary response between ergonovine and acetylcholine in the same patients. Acetylcholine is supersensitive for females; spasm provoked by ergonovine is focal and proximal, whereas provoked spasm by acetylcholine is diffuse and distal...
January 2017: Journal of Cardiology
Sung Woo Cho, Taek Kyu Park, Hye Bin Gwag, A Young Lim, Min Seok Oh, Da Hyon Lee, Choong Sil Seong, Jeong Hoon Yang, Young Bin Song, Joo-Yong Hahn, Jin-Ho Choi, Sang Hoon Lee, Hyeon-Cheol Gwon, Seung-Hyuk Choi
BACKGROUND: Coronary vasospasm is an important pathogenesis of acute coronary syndrome (ACS). However, the clinical features and prognosis of vasospastic angina (VA) patients presenting with ACS (VAACS) are still unclear. We aimed to evaluate the clinical characteristics and long-term outcomes of VAACS patients without significant coronary artery stenosis. METHODS AND RESULTS: A total of 986 VA patients confirmed by ergonovine provocation test were analyzed. VAACS was defined as VA patients visiting the emergency room with documented electrocardiographic changes, significant arrhythmias, or elevated cardiac biomarkers...
November 16, 2016: Journal of the American Heart Association
Futoshi Yamanaka, Koki Shishido, Tomoki Ochiai, Noriaki Moriyama, Kazuki Tobita, Tomoyuki Tani, Kyosuke Furuhashi, Kazuya Sugitatsu, Daisuke Hachinohe, Tadashi Wada, Shingo Mizuno, Hidetaka Suenaga, Yutaka Tanaka, Masato Murakami, Junya Matsumi, Saeko Takahashi, Takeshi Akasaka, Shinji Tanaka, Shigeru Saito
OBJECTIVE: Multi-slice computed tomography (MSCT) coronary angiography has been reported as an effective alternative to invasive conventional coronary angiography (CCA) for the diagnosis of coronary artery disease (CAD). However, in previous reports, the diagnostic accuracy of MSCT has not been significant enough to be of benefit in symptomatic patients. The aim of this study was to identify the usefulness of 320-slice computed tomography coronary angiography (320-CTA) for symptomatic patients in terms of the diagnostic accuracy of 320-CTA and the prevalence of vasospastic angina pectoris (VSAP) within the study cohort...
September 29, 2016: European Journal of Internal Medicine
Min Seok Oh, Jeong Hoon Yang, Da Hyun Lee, Taek Kyu Park, Young Bin Song, Joo-Yong Hahn, Jin-Ho Choi, Sang Hoon Lee, Hyeon-Cheol Gwon, Seung-Hyuk Choi
BACKGROUND: Limited data are available on the efficacy of statin therapy for secondary prevention in patients with vasospastic angina (VSA). We investigated the association of statin therapy with long-term clinical outcomes in VSA patients without significant coronary artery disease. METHODS: From January 2003 to June 2014, we enrolled a total of 804 patients with VSA proven by an ergonovine provocation test without significant (≥70% diameter stenosis) coronary artery disease...
November 15, 2016: International Journal of Cardiology
Tsuyoshi Ito, Hiroshi Fujita, Taku Ichihashi, Nobuyuki Ohte
OBJECTIVE: Endothelial dysfunction of the coronary artery is thought to lead to the development of coronary spasms. Epicardial adipose tissue may be a marker of coronary atherosclerosis. This study investigated the diagnostic impact of epicardial fat volume (EFV), quantified with non-contrast electrocardiogram (ECG)-gated computed tomography (CT), on ergonovine-induced coronary spasms. METHODS: We included 97 patients with suspected coronary spastic angina who underwent ECG-gated CT and an ergonovine provocation test...
October 15, 2016: International Journal of Cardiology
A Young Lim, Taek Kyu Park, Sung Woo Cho, Min Seok Oh, Da Hyon Lee, Choong Sil Seong, Hye Bin Gwag, Jeong Hoon Yang, Young Bin Song, Joo-Yong Hahn, Jin-Ho Choi, Sang Hoon Lee, Hyeon-Cheol Gwon, Joonghyun Ahn, K C Carriere, Seung-Hyuk Choi
BACKGROUND: High-dose aspirin has been reported to exacerbate coronary artery spasm in patients with vasospastic angina. We investigated clinical implications of low-dose aspirin on vasospastic angina patients without significant coronary artery stenosis. METHODS: We included patients without significant coronary artery stenosis on coronary angiography (CAG) and with positive results on intracoronary ergonovine provocation test between January 2003 and December 2014...
October 15, 2016: International Journal of Cardiology
Eun-Ju Kang, Moo Hyun Kim, Cai De Jin, Jeongmin Seo, Dong Won Kim, Seong Kuk Yoon, Tae-Ho Park, Ki-Nam Lee, Sang Il Choi, Yeonyee Elizabeth Yoon
OBJECTIVES: To evaluate the feasibility of a double-acquisition coronary CT angiography (CCTA) protocol in the presence and absence of an intravenous (IV) vasodilator infusion for detecting vasospastic angina. METHODS: Twenty patients with a high clinical probability of vasospastic angina were enrolled. All subjects underwent baseline CCTA without a vasodilator in the early morning followed by a catheterized coronary angiography with ergonovine provocation test...
March 2017: European Radiology
Berrin Günaydın, Mertihan Kurdoğlu, İsmail Güler, Mehrnoosh Bashiri, Fırat Büyüktaşkın, Mine Dağgez Keleşoğlu, Gözde İnan
Abnormal placental attachments, such as placenta accreta, increta or percrata, can result in increased morbidity and mortality because of the risk of severe postpartum haemorrhage. We aimed to present the management of spinal anaesthesia and surgical approach for emergent caesarean section because of vaginal bleeding in a multiparous pregnant woman with placenta previa at 36 weeks' gestation. Hyperbaric bupivacaine 12 mg, fentanyl 10 μg and morphine 150 μg were intrathecally administered for spinal anaesthesia...
February 2016: Turkish Journal of Anaesthesiology and Reanimation
Tomonari Koike, Shiori Tamura, Ying Yu, Nobue Kuniyoshi, Masashi Shiomi
We examined the relationship between atherosclerosis and the provocation of coronary spasm as well as the influence of coronary spasm on the onset of acute ischemic myocardial disease. Coronary spasm was provoked in anesthetized normal Japanese white (JW) rabbits and myocardial infarction-prone Watanabe heritable hyperlipidemic (WHHLMI) rabbits, an animal model for coronary atherosclerosis and myocardial infarction, by injecting ergonovine during the infusion of norepinephrine through a marginal ear vein. A decrease in contrast flow in the left circumflex artery was observed on coronary angiograms...
November 1, 2016: Experimental Animals
Shozo Sueda, Hiroaki Kohno
Pharmacological spasm provocation tests are invasive methods and we always have the potential to encounter complications when performing these tests. In 1980, Buxton et al. reported three deaths when they performed intravenous ergonovine testing. However, we now employ the intracoronary ergonovine test instead of the intravenous injection of ergonovine from a safety procedure point of view. Past serious major complications of intravenous ergonovine tests, intracoronary ergonovine tests, and intracoronary acetylcholine tests were 0...
July 2016: Journal of Cardiology
Mi-Hyang Jung, Dong Il Shin, Ik Jun Choi, Suk Min Seo, Sooa Choi, Mahn Won Park, Pum-Joon Kim, Sang Hong Baek, Ki-Bae Seung
PURPOSE: The association between the red cell distribution width (RDW) and vasospastic angina (VSA) has not been elucidated. We investigated the association of the RDW with the incidence and angiographic subtypes of VSA in Korean patients. MATERIALS AND METHODS: A total of 460 patients who underwent intracoronary ergonovine provocation tests were consecutively enrolled and classified into two groups: the VSA group (n=147, 32.0%) and non-VSA group (n=313, 68.0%)...
May 2016: Yonsei Medical Journal
Erin Rayner-Hartley, Annie Chou, Jacqueline Saw, Tara Sedlak
Kounis syndrome is defined as an acute coronary syndrome triggered by allergic or hypersensitivity reactions resulting in mast cell and platelet activation. Numerous causes have been described, including various drugs, medical conditions, and environmental exposures. Samter's triad consists of nasal polyps, asthma, and aspirin (or nonsteroidal anti-inflammatory drug) sensitivity. We describe a case of Kounis type I in a young woman with Samter's triad who presented with cardiac arrest on 3 occasions. Ergonovine provocation testing established the diagnosis of coronary vasospasm...
December 18, 2015: Canadian Journal of Cardiology
Soo Jin Kim, Ji Young Juong, Tae-Ho Park
A 68-year-old man was admitted for a syncope workup. After routine evaluation, he was diagnosed with syncope of an unknown cause and was discharged from the hospital. He was readmitted due to dizziness. On repeated Holter monitoring, polymorphic ventricular tachycardia was detected during syncope. We performed intracoronary ergonovine provocation test; severe coronary spasm was induced at 70% stenosis of the proximal left anterior descending artery. The patient was treated with percutaneous coronary intervention...
January 2016: Korean Circulation Journal
H-J Jang, T-H Kim, S W Kwon, J-Y Kim, J S Kim, H J Lee, J S Park, R K Choi, Y J Choi, W-H Shim
BACKGROUND: Recent consensus on variant angina defines significant spasm as total or subtotal occlusion of a coronary artery. However, the clinical significance of "less-than-subtotal" spasm needs to be reappraised, especially if the coronary spasm is combined with chest pain. Therefore, we evaluated the feasibility of left ventricular end diastolic pressure (LVEDP) as a tool to detect myocardial ischemia during ergonovine provocation testing. METHODS: After achieving two access sites, 29 patients underwent successful LVEDP monitoring using 5-Fr pigtail catheters during ergonovine provocation tests...
June 2016: Herz
Alan K Jarmusch, Ashleigh M Musso, Tatsiana Shymanovich, Scott A Jarmusch, Miranda J Weavil, Mary E Lovin, Brandie M Ehrmann, Susanna Saari, David E Nichols, Stanley H Faeth, Nadja B Cech
Ergot alkaloids are mycotoxins with an array of biological effects. With this study, we investigated for the first time the application of atmospheric pressure photoionization (APPI) as an ionization method for LC-MS analysis of ergot alkaloids, and compared its performance to that of the more established technique of electrospray ionization (ESI). Samples of the grass Achnatherum robustum infected with the ergot producing Epichloë fungus were extracted using cold methanol and subjected to reserved-phase HPLC-ESI-MS and HPLC-APPI-MS analysis...
January 5, 2016: Journal of Pharmaceutical and Biomedical Analysis
Shozo Sueda, Hiroaki Kohno, Takaaki Ochi, Tadao Uraoka
The acetylcholine (ACh) spasm provocation test proposed by Yasue, Okumura et al more than a quarter-century ago has become a popular method for induction of coronary spasm. This test is safe and has a low rate of complications. However, it may be limited in its ability to document attacks in daily life because previously it was the gold-standard method for diagnosing active variant angina. There may be some clinical issues to modify for the next generation of cardiologists. A maximal ACh dose of 50/100 µg in the right coronary artery/left coronary artery is recommended in the Japanese Circulation Society guidelines...
July 2015: Clinical Cardiology
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