Korean Circ J.  2013 Mar;43(3):199-203. 10.4070/kcj.2013.43.3.199.

Does a Negative Ergonovine Provocation Test Truly Predict Freedom from Variant Angina?

• Kim YG
• Kim HJ
• Choi WS
• Im MS
• Yoon CH
• Suh JW
• Choi DJ

• KMID: 2224967
• DOI: http://doi.org/10.4070/kcj.2013.43.3.199

Abstract

Ergonovine provocation test is known to be very sensitive for diagnosing variant angina. The patient described in this study initially presented with atypical chest pain and underwent coronary angiography and ergonovine provocation tests, which were negative. The patient was subsequently prescribed a proton pump inhibitor and prokinetics for pain relief, but then presented with acute myocardial infarction and cardiogenic shock due to coronary artery vasospasm 5 years later. This case suggests that ergonovine provocation test generates false negative results, which can lead to unwanted outcomes. Even with a negative ergonovine provocation test, prescription of calcium channel blockers or nitrates should be considered in patients with a clinical history suggestive of variant angina.

Keyword

Angina pectoris, variant; Ergonovine; Coronary vasospasm

MeSH Terms

Angina Pectoris, Variant
Calcium Channel Blockers
Chest Pain
Coronary Angiography
Coronary Vasospasm
Ergonovine
Humans
Myocardial Infarction
Nitrates
Prescriptions
Proton Pump Inhibitors
Shock, Cardiogenic
Calcium Channel Blockers
Ergonovine
Nitrates

Figure

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  Fig. 1 Coronary angiography at 2007-11-12. Coronary angiography after ergonovine (0.2 mg IV bolus twice) provocation test. A: left main, left anteriordescending and left circumflex coronary arteries showing no significant vasospasm. B: right coronary arteryshowing no significant vasospasm. C and D: coronary angiography obtained after nitroglycerine 200 mcg intra-coronary injection.

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  Fig. 2 Electrocardiogram (ECG) at 2012-01-15. ECG on admission, showing no ST-T abnormalities.

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  Fig. 3 Coronary angiography at 2012-01-15 (before nitroglycerine injection). Coronary angiography showing no abnormalities in the left main, left anterior descending, and left circumflexarteries.

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  Fig. 4 Coronary angiography at 2012-01-15 (before nitroglycerine injection). A and B: coronary angiography showing total occlusion of the distal right coronary artery, posterior descendingartery, and posterolateral branch bifurcation segment. White arrows show the location of spasm.

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  Fig. 5 Coronary angiography at 2012-01-15 (after nitroglycerine injection). Total occlusion of the distal right coronary artery, posterior descending artery, and posterolateral branchbifurcation segment were relieved.

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