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Case Reports
. 2024 Aug 1;8(8):ytae386.
doi: 10.1093/ehjcr/ytae386. eCollection 2024 Aug.

Do electrocardiographic changes induced during intracoronary vasospasm provocation testing reflect those during spontaneous angina episodes in patients with vasospastic angina?: a case series

Rutger G T Feenstra  1 , Lotte S Timmerman  1 , Jan J Piek  1 , Marcel A M Beijk  1
Affiliations
Case Reports

Do electrocardiographic changes induced during intracoronary vasospasm provocation testing reflect those during spontaneous angina episodes in patients with vasospastic angina?: a case series

Rutger G T Feenstra et al. Eur Heart J Case Rep. .

Abstract

Background: According to the Coronary Vasomotor Disorders International Study (COVADIS) group, the ECG criteria supporting the diagnosis of vasospastic angina (VSA) in spontaneous episodes or induced during intracoronary spasm testing are similar. However, it remains elusive whether acetylcholine-induced ECG changes during epicardial spasms reflect ECG changes that occur during the height of a spontaneous episode.

Case summary: We present four patients diagnosed with VSA during intracoronary spasm testing, of whom the ECG characteristics during spasm testing and a spontaneous angina episode are described. All patients have >90% coronary epicardial vasoconstriction in one or more vessels during acetylcholine provocation. ECGs at the height of a spontaneous episode and during acetylcholine-induced coronary spasm are found to be different in three out of four patients.

Discussion: In patients with VSA, the ECG at the height of a spontaneous episode and during acetylcholine-induced coronary artery spasm may differ substantially. In patients with symptoms suspicious of VSA, every effort should be undertaken to obtain ECGs during the height of a spontaneous episode of angina pectoris and there should be a low threshold to perform intracoronary function testing.

Keywords: Case report; Electrocardiogram; Epicardial vasospasm; Intracoronary spasm testing; Vasomotor dysfunction; Vasospastic angina.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Case 1: (A) ECG at the height of a spontaneous episode of angina. (B) ECG during maximal coronary spasm. (C) ECG at rest. (D) Angiography of left coronary artery during maximal epicardial spasm. (E) Angiography of left coronary artery after intracoronary nitroglycerine.
Figure 2
Figure 2
Case 2: (A) ECG at the height of a spontaneous episode of angina. (B) ECG during maximal coronary spasm. (C) ECG at rest. (D) Angiography of right coronary artery during maximal epicardial spasm. (E) Angiography of right coronary artery after intracoronary nitroglycerine.
Figure 3
Figure 3
Case 3: (A) ECG at the height of a spontaneous episode of angina. (B) ECG during maximal coronary spasm. (C) ECG at rest. (D) Angiography of left coronary artery during maximal epicardial spasm. (E) Angiography of left coronary artery after intracoronary nitroglycerine.
Figure 4
Figure 4
Case 4: (A) ECG at the height of a spontaneous episode of angina. (B) ECG during maximal coronary spasm. (C) ECG at rest. (D) Angiography of left coronary artery during maximal epicardial spasm. (E) Angiography of left coronary artery after intracoronary nitroglycerine.
Figure 5
Figure 5
Diagnostic management of (M)INOCA patients.
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