Coronary Spastic Angina Induced after Oral Desmopressin (DDAVP) Administration

Abstract

A 60-year-old man was prescribed oral desmopressin (1-deamino-8-D-arginine vasopressin acetate trihydrate; DDAVP) for nocturnal polyuria. One week after starting to take desmopressin, he frequently felt chest pain while resting. Coronary angiography revealed no organic stenosis; however, an acetylcholine provocation test showed severe coronary spasm with ST elevation. He was diagnosed with coronary spastic angina, and we stopped the oral desmopressin and added diltiazem. While DDAVP should dilate the coronary vessels in healthy subjects, it may provoke coronary vasospasm in patients with endothelial dysfunction. We should be careful to avoid triggering coronary spasm when administering DDAVP to patients that may have potential endothelial dysfunction.

Figure 1.

ECG on admission. ECG on admission showed sinus rhythm (heart rate=76 beats per minute) without any significant ST-T changes.

Figure 2.

Coronary angiography and the acetylcholine provocation test. (a) The left cranial view of the left coronary artery. (b) The right caudal view of the left coronary artery. There was no organic stenosis, including in-stent restenosis. (c) The left cranial view of the left coronary artery after the administration of acetylcholine chloride. (d) The right caudal view of the left coronary artery after the administration of acetylcholine chloride. Excessive coronary spasm was induced only by 20 µg administration of acetylcholine chloride. The drug-eluting stent previously implanted in the left circumflex artery is indicated by arrows.

Figure 3.

ECG during acetylcholine provocation test. ST segment elevation was observed in leads I, aVL, and V2-6 accompanied by reciprocal changes in leads II, III, and aVF.