Korean Circ J.  2011 Apr;41(4):220-223. 10.4070/kcj.2011.41.4.220.

A Case of Variant Angina Developing Transient Collateral Circulation During Vasospasm

• Lee WS
• Kim DH
• Park KS
• Woo SI
• Shin SH
• Jun K
• Cheon W
• Jeong ES
• Park SD

• KMID: 2028949
• DOI: http://doi.org/10.4070/kcj.2011.41.4.220

Abstract

Variant angina is characterized by spontaneous episodes of angina, usually occurring in the morning and having ST segment elevation on the electrocardiogram. However, in the case presented here, vasospasm and angina was shown by ergonovine without ST elevation. The patient was a 60-year-old man who presented with a 2-year history of frequent chest pain. There were no abnormalities in coronary angiography. When ergonovine (100 microg) was injected, total occlusion of the proximal right coronary artery was seen, without ST elevation at the electrocardiogram. The cause was collateral from left anterior descending artery to distal right coronary artery at the left coronary angiography. Therefore, in a patient with variant angina without ST elevation, a transient collateral circulation during vasospasm should be considered.

Keyword

Angina pectoris, variant; Ergonovine; Collateral circulation

MeSH Terms

Angina Pectoris, Variant
Arteries
Chest Pain
Collateral Circulation
Coronary Angiography
Coronary Vessels
Electrocardiography
Ergonovine
Humans
Middle Aged
Ergonovine

Figure

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  Fig. 1 Electrocardiogram on admission, showing no ST-T abnormalities.

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  Fig. 2 Coronary angiography. A: left coronary angiography: a left anterior descending artery showing no abnormalities and mild stenosis at the left circumflex artery. B: a right coronary artery showing no abnormalities.

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  Fig. 3 Coronary angiography with ergonovine (100 µg by injection). A: left coronary angiography: left anterior descending artery showing no abnormalities and mild artery spasm at the left circumflex artery. A collateral is seen from the left anterior descending artery to the distal right coronary artery (arrow). B: a right coronary artery showing total occlusion at the proximal artery due to arterial spasm.

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  Fig. 4 Electrocardiogram with ergonovine (100 µg by injection). Although the proximal right coronary artery was total occluded, no ST-T abnormalities were seen.

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  Fig. 5 Coronary angiography after nitroglycerin was injected. A: left coronary artery: left anterior descending and left circumflex artery became normal. The collateral artery seen at ergonovine injection disappeared. B: the right coronary artery also became normal.

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