{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T20:28:03Z","timestamp":1746736083510,"version":"3.28.0"},"reference-count":15,"publisher":"Texas Heart Institute Journal","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022]]},"abstract":"<jats:p>Acute vasospastic angina, formerly known as Prinzmetal angina, is characterized by transient electrocardiographic changes that are not related to exertion. Its atypical presentation makes it difficult to establish the diagnosis, so it is probably underrecognized and therefore mismanaged. We treated a 49-year-old woman who presented with a 2-day history of chest pain associated with palpitations. Abnormal radionuclide stress test results prompted diagnostic coronary angiography, during which the patient reported chest pain and became hemodynamically unstable. Active coronary vasospasm at multiple sites was treated with intracoronary nitroglycerin and nicardipine, leading to immediate recovery.<\/jats:p>\n        <jats:p>Our case highlights the importance of accurate, timely diagnosis of vasospastic angina, and of early recognition and management of spontaneous coronary spasm during angiography.<\/jats:p>","DOI":"10.14503\/thij-20-7357","type":"journal-article","created":{"date-parts":[[2022,4,4]],"date-time":"2022-04-04T13:49:24Z","timestamp":1649080164000},"source":"Crossref","is-referenced-by-count":2,"title":["Spontaneous Multivessel Coronary Spasm During Diagnostic Coronary Angiography"],"prefix":"10.14503","volume":"49","author":[{"given":"Ramses Ramirez","family":"Damera","sequence":"first","affiliation":[{"name":"College of Medicine, University of Central Florida; Orlando, Florida"},{"name":"Department of Internal Medicine, HCA Healthcare Greater Orlando; Orlando, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad","family":"Ijlal Khan","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Central Florida; Orlando, Florida"},{"name":"Department of Internal Medicine, HCA Healthcare Greater Orlando; Orlando, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Volodymyr","family":"Oliynyk","sequence":"additional","affiliation":[{"name":"College of Medicine, University of Central Florida; Orlando, Florida"},{"name":"Department of Internal Medicine, HCA Healthcare Greater Orlando; Orlando, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aamir","family":"Javaid","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Osceola Regional Medical Center, Kissimmee, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"5628","reference":[{"key":"i1526-6702-49-2-e207357-b1","series-title":"Am J Med","first-page":"375","article-title":"Angina pectoris. I. A variant form of angina pectoris; preliminary report","volume":"27","year":"1959","unstructured":"Prinzmetal\n              M,\n            \n            \n              Kennamer\n              R,\n            \n            \n              Merliss\n              R,\n            \n            \n              Wada\n              T,\n            \n            \n              Bor\n              N.\n            \n          \n          Angina pectoris. I. A variant form of angina pectoris; preliminary report.\n\t\t\t\t\tAm J Med1959;27:375\u201388."},{"issue":"2","key":"i1526-6702-49-2-e207357-b2","series-title":"Int J Cardiol","first-page":"121","article-title":"Comparison of the risk factors for coronary artery spasm with those for organic stenosis in a Japanese population: role of cigarette smoking","volume":"72","year":"2000","unstructured":"Takaoka\n              K,\n            \n            \n              Yoshimura\n              M,\n            \n            \n              Ogawa\n              H,\n            \n            \n              Kugiyama\n              K,\n            \n            \n              Nakayama\n              M,\n            \n            \n              Shimasaki\n              Y,\n            \n          \n          .\n\t\t\t\t\tComparison of the risk factors for coronary artery spasm with those for organic stenosis in a Japanese population: role of cigarette smoking.\n\t\t\t\t\tInt J Cardiol2000;72(2):121\u20136."},{"issue":"10","key":"i1526-6702-49-2-e207357-b3","series-title":"Expert Rev Cardiovasc Ther","first-page":"727","article-title":"Intracoronary nitroglycerin: recognizing coronary spasm first and foremost to avoid unnecessary coronary stents","volume":"15","year":"2017","unstructured":"Vishnevsky\n              A,\n            \n            \n              Fischman\n              DL,\n            \n            \n              Savage\n              MP.\n            \n          \n          Intracoronary nitroglycerin: recognizing coronary spasm first and foremost to avoid unnecessary coronary stents.\n\t\t\t\t\tExpert Rev Cardiovasc Ther2017;15(10):727\u20138."},{"issue":"4","key":"i1526-6702-49-2-e207357-b4","series-title":"Am J Cardiol","first-page":"571","article-title":"Angiographic characteristics of catheter-induced spasm of the left main coronary artery","volume":"117","year":"2016","unstructured":"Ilia\n              R,\n            \n            \n              Shimony\n              A,\n            \n            \n              Cafri\n              C,\n            \n            \n              Weinstein\n              JM.\n            \n          \n          Angiographic characteristics of catheter-induced spasm of the left main coronary artery.\n\t\t\t\t\tAm J Cardiol2016;117(4):571\u20133."},{"issue":"33","key":"i1526-6702-49-2-e207357-b5","series-title":"Eur Heart J","first-page":"2565","article-title":"International standardization of diagnostic criteria for vasospastic angina","volume":"38","year":"2017","unstructured":"Beltrame\n              JF,\n            \n            \n              Crea\n              F,\n            \n            \n              Kaski\n              JC,\n            \n            \n              Ogawa\n              H,\n            \n            \n              Ong\n              P,\n            \n            \n              Sechtem\n              U,\n            \n          \n          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patients with variant angina.\n\t\t\t\t\tJ Am Coll Cardiol2002;40(2):266\u201370."},{"issue":"1","key":"i1526-6702-49-2-e207357-b7","series-title":"Am Heart J","first-page":"32","article-title":"Statistical analysis of clinical risk factors for coronary artery spasm: identification of the most important determinant","volume":"124","year":"1992","unstructured":"Nobuyoshi\n              M,\n            \n            \n              Abe\n              M,\n            \n            \n              Nosaka\n              H,\n            \n            \n              Kimura\n              T,\n            \n            \n              Yokoi\n              H,\n            \n            \n              Hamasaki\n              N,\n            \n          \n          .\n\t\t\t\t\tStatistical analysis of clinical risk factors for coronary artery spasm: identification of the most important determinant.\n\t\t\t\t\tAm Heart J1992;124(1):32\u20138."},{"issue":"7","key":"i1526-6702-49-2-e207357-b8","series-title":"Circulation","first-page":"1749","article-title":"Insulin resistance associated with compensatory hyperinsulinemia as an independent risk factor for vasospastic angina","volume":"92","year":"1995","unstructured":"Shinozaki\n              K,\n            \n            \n              Suzuki\n              M,\n            \n            \n              Ikebuchi\n              M,\n            \n            \n              Takaki\n              H,\n            \n            \n              Hara\n              Y,\n            \n            \n              Tsushima\n              M,\n            \n            \n              Harano\n              Y.\n            \n          \n          Insulin resistance associated with compensatory hyperinsulinemia as an independent risk factor for vasospastic angina.\n\t\t\t\t\tCirculation1995;92(7):1749\u201357."},{"issue":"6","key":"i1526-6702-49-2-e207357-b9","series-title":"J Am Coll Cardiol","first-page":"1458","article-title":"Impaired glucose tolerance with late hypersecretion of insulin during oral glucose tolerance test in patients with vasospastic angina","volume":"27","year":"1996","unstructured":"Suzuki\n              M,\n            \n            \n              Nishizaki\n              M,\n            \n            \n              Arita\n              M,\n            \n            \n              Kakuta\n              T,\n            \n            \n              Numano\n              F.\n            \n          \n          Impaired glucose tolerance with late hypersecretion of insulin during oral glucose tolerance test in patients with vasospastic angina.\n\t\t\t\t\tJ Am Coll Cardiol1996;27(6):1458\u201363."},{"issue":"11","key":"i1526-6702-49-2-e207357-b10","series-title":"Circ J","first-page":"2779","article-title":"Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) (JCS 2013)","volume":"78","year":"2014","unstructured":"JCS Joint Working Group.\n\t\t\t\t\t\n          Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) (JCS 2013).\n\t\t\t\t\tCirc J2014;78(11):2779\u2013801."},{"issue":"2","key":"i1526-6702-49-2-e207357-b11","series-title":"Coron Artery Dis","first-page":"96","article-title":"Coronary artery spasm and thyrotoxicosis: the best index is that of suspicion","volume":"25","year":"2014","unstructured":"Goldstein\n              JA.\n            \n          \n          Coronary artery spasm and thyrotoxicosis: the best index is that of suspicion.\n\t\t\t\t\tCoron Artery Dis2014;25(2):96\u20137."},{"issue":"5","key":"i1526-6702-49-2-e207357-b12","series-title":"J Invasive Cardiol","first-page":"289","article-title":"Refractory vasomotor angina in subclinical hyperthyroidism demonstrating focal and segmental coronary vasoconstriction","volume":"15","year":"2003","unstructured":"DeTommasi\n              A,\n            \n            \n              Rogge\n              S,\n            \n            \n              Houghton\n              JL.\n            \n          \n          Refractory vasomotor angina in subclinical hyperthyroidism demonstrating focal and segmental coronary vasoconstriction.\n\t\t\t\t\tJ Invasive Cardiol2003;15(5):289\u201392."},{"issue":"3","key":"i1526-6702-49-2-e207357-b13","series-title":"Eur Heart J","first-page":"267","article-title":"2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)","volume":"37","year":"2016","unstructured":"Roffi\n              M,\n            \n            \n              Patrono\n              C,\n            \n            \n              Collet\n              JP,\n            \n            \n              Mueller\n              C,\n            \n            \n              Valgimigli\n              M,\n            \n            \n              Andreotti\n              F,\n            \n          \n          .\n\t\t\t\t\t2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC).\n\t\t\t\t\tEur Heart J2016;37(3):267\u2013315."},{"issue":"18","key":"i1526-6702-49-2-e207357-b14","series-title":"J Am Coll Cardiol","first-page":"1742","article-title":"Effects of a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, fluvastatin, on coronary spasm after withdrawal of calcium-channel blockers","volume":"51","year":"2008","unstructured":"Yasue\n              H,\n            \n            \n              Mizuno\n              Y,\n            \n            \n              Harada\n              E,\n            \n            \n              Itoh\n              T,\n            \n            \n              Nakagawa\n              H,\n            \n            \n              Nakayama\n              M,\n            \n          \n          .\n\t\t\t\t\tEffects of a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, fluvastatin, on coronary spasm after withdrawal of calcium-channel blockers.\n\t\t\t\t\tJ Am Coll Cardiol2008;51(18):1742\u20138."},{"issue":"5","key":"i1526-6702-49-2-e207357-b15","series-title":"J Am Heart Assoc","first-page":"e003426","article-title":"Impact of statin therapy on clinical outcome in patients with coronary spasm","volume":"5","year":"2016","unstructured":"Ishii\n              M,\n            \n            \n              Kaikita\n              K,\n            \n            \n              Sato\n              K,\n            \n            \n              Yamanaga\n              K,\n            \n            \n              Miyazaki\n              T,\n            \n            \n              Akasaka\n              T,\n            \n          \n          .\n\t\t\t\t\tImpact of statin therapy on clinical outcome in patients with coronary spasm.\n\t\t\t\t\tJ Am Heart Assoc2016;5(5):e003426."}],"container-title":["Texas Heart Institute 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