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Ergonovine Stress Echocardiography for the Diagnosis of Vasospastic Angina

  • Jae-Kwan Song
  • Eugenio Picano

Coronary artery spasm has been considered one of the major mechanisms causing dynamic stenosis of epicardial coronary arteries, which can evoke acute myocardial ischemia. Vasospastic angina caused by coronary artery spasm has a wide clinical spectrum: one of its typical clinical manifestations is variant angina. Coronary vasospasm has also been documented to contribute to the development of unstable angina or acute myocardial infarction [1]. Classically, coronary artery spasm is diagnosed by an invasive provocative procedure during diagnostic coronary angiography. Since various noninvasive diagnostic tests for fixed atherosclerotic stenosis of epicardial coronary arteries (exercise ECG, stress echocardiography, and nuclear tests) are being used in routine daily practice, it would be useful to establish a reliable, noninvasive, and safe diagnostic method to document coronary artery spasm in the management of patients with vasospastic angina.

The rare episodic nature of coronary artery spasm makes it extremely difficult to document spontaneous coronary vasospasm in clinical practice. The noninvasive stress tests currently used are ergonovine [2], acetylcholine [3], and systemic alkalosis by hyperven-tilation [4]. Of these, spasm-provocation testing using ergonovine is considered the gold standard for diagnosis of coronary artery spasm because of its high sensitivity and specificity. Acetylcholine seems to have comparable diagnostic validity for intracoronary administration, but its short half-life for the abundant pseudocholinesterase in human plasma makes intravenous injection inadequate for spasm provocation.

Keywords

Stress Echocardiography Regional Wall Motion Abnormality Coronary Artery Spasm Coronary Vasospasm Variant Angina 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Jae-Kwan Song
    • 1
  • Eugenio Picano
    1. 1.Echo Laboratory, Asan Medical Center Department of Pulmonary and Critical Care Medicine, Asan Medical CenterUniversity of Ulsan, College of MedicineSongpa-gu SeoulRepublic of Korea

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