Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med. 1959 Sep. 27:375-88. [QxMD MEDLINE Link].
Maseri A, Severi S, Nes MD, et al. "Variant" angina: one aspect of a continuous spectrum of vasospastic myocardial ischemia. Pathogenetic mechanisms, estimated incidence and clinical and coronary arteriographic findings in 138 patients. Am J Cardiol. 1978 Dec. 42(6):1019-35. [QxMD MEDLINE Link].
Yasue H, Omote S, Takizawa A, Nagao M, Miwa K, Tanaka S. Circadian variation of exercise capacity in patients with Prinzmetal's variant angina: role of exercise-induced coronary arterial spasm. Circulation. 1979 May. 59(5):938-48. [QxMD MEDLINE Link].
Yasue H, Nakagawa H, Itoh T, Harada E, Mizuno Y. Coronary artery spasm--clinical features, diagnosis, pathogenesis, and treatment. J Cardiol. 2008 Feb. 51(1):2-17. [QxMD MEDLINE Link].
Ajani AE, Yan BP. The mystery of coronary artery spasm. Heart Lung Circ. 2007 Feb. 16(1):10-5. [QxMD MEDLINE Link].
Yasue H, Touyama M, Kato H, Tanaka S, Akiyama F. Prinzmetal's variant form of angina as a manifestation of alpha-adrenergic receptor-mediated coronary artery spasm: documentation by coronary arteriography. Am Heart J. 1976 Feb. 91(2):148-55. [QxMD MEDLINE Link].
Yasue H, Horio Y, Nakamura N, et al. Induction of coronary artery spasm by acetylcholine in patients with variant angina: possible role of the parasympathetic nervous system in the pathogenesis of coronary artery spasm. Circulation. 1986 Nov. 74(5):955-63. [QxMD MEDLINE Link].
Kaneda H, Taguchi J, Kuwada Y, et al. Coronary artery spasm and the polymorphisms of the endothelial nitric oxide synthase gene. Circ J. 2006 Apr. 70(4):409-13. [QxMD MEDLINE Link].
Nishijima T, Nakayama M, Yoshimura M, et al. The endothelial nitric oxide synthase gene -786T/C polymorphism is a predictive factor for reattacks of coronary spasm. Pharmacogenet Genomics. 2007 Aug. 17(8):581-7. [QxMD MEDLINE Link].
Egashira K, Katsuda Y, Mohri M, et al. Basal release of endothelium-derived nitric oxide at site of spasm in patients with variant angina. J Am Coll Cardiol. 1996 May. 27(6):1444-9. [QxMD MEDLINE Link].
Nakano T, Osanai T, Tomita H, Sekimata M, Homma Y, Okumura K. Enhanced activity of variant phospholipase C-delta1 protein (R257H) detected in patients with coronary artery spasm. Circulation. 2002 Apr 30. 105(17):2024-9. [QxMD MEDLINE Link].
Stern S, Bayes de Luna A. Coronary artery spasm: a 2009 update. Circulation. 2009 May 12. 119(18):2531-4. [QxMD MEDLINE Link].
Adlam D, Azeem T, Ali T, Gershlick A. Is there a role for provocation testing to diagnose coronary artery spasm?. Int J Cardiol. 2005 Jun 22. 102(1):1-7. [QxMD MEDLINE Link].
Harding MB, Leithe ME, Mark DB, et al. Ergonovine maleate testing during cardiac catheterization: a 10-year perspective in 3,447 patients without significant coronary artery disease or Prinzmetal's variant angina. J Am Coll Cardiol. 1992 Jul. 20(1):107-11. [QxMD MEDLINE Link].
Bertrand ME, LaBlanche JM, et al. Frequency of provoked coronary arterial spasm in 1089 consecutive patients undergoing coronary arteriography. Circulation. 1982 Jun. 65(7):1299-306. [QxMD MEDLINE Link].
Sueda S, Kohno H, Fukuda H, et al. Frequency of provoked coronary spasms in patients undergoing coronary arteriography using a spasm provocation test via intracoronary administration of ergonovine. Angiology. 2004 Jul-Aug. 55(4):403-11. [QxMD MEDLINE Link].
Sueda S, Kohno H, Oshita A, et al. Coronary abnormal response has increased in Japanese patients: Analysis of 17 years' spasm provocation tests in 2093 cases. J Cardiol. 2010 May. 55(3):354-361. [QxMD MEDLINE Link].
Bory M, Pierron F, Panagides D, Bonnet JL, Yvorra S, Desfossez L. Coronary artery spasm in patients with normal or near normal coronary arteries. Long-term follow-up of 277 patients. Eur Heart J. 1996 Jul. 17(7):1015-21. [QxMD MEDLINE Link].
Mayer S, Hillis LD. Prinzmetal's variant angina. Clin Cardiol. 1998 Apr. 21(4):243-6. [QxMD MEDLINE Link].
Selzer A, Langston M, Ruggeroli C, Cohn K. Clinical syndrome of variant angina with normal coronary arteriogram. N Engl J Med. 1976 Dec 9. 295(24):1343-7. [QxMD MEDLINE Link].
Rha SW, Park JY, Ryu SK, et al. TCT-437 The impact of gender difference on angiographic characteristics during intracoronary acetylcholine provocation test in Korean patients. J Am Coll Cardiol. 2012 Oct 23. 60(17 Supp B):B124.
Pristipino C, Beltrame JF, Finocchiaro ML, et al. Major racial differences in coronary constrictor response between Japanese and Caucasians with recent myocardial infarction. Circulation. 2000 Mar 14. 101(10):1102-8. [QxMD MEDLINE Link].
Bott-Silverman C, Heupler FA Jr. Natural history of pure coronary artery spasm in patients treated medically. J Am Coll Cardiol. 1983 Aug. 2(2):200-5. [QxMD MEDLINE Link].
Mishra PK. Variations in presentation and various options in management of variant angina. Eur J Cardiothorac Surg. 2006 May. 29(5):748-59. [QxMD MEDLINE Link].
Yasue H, Takizawa A, Nagao M, et al. Long-term prognosis for patients with variant angina and influential factors. Circulation. 1988 Jul. 78(1):1-9. [QxMD MEDLINE Link].
Onaka H, Hirota Y, Shimada S, et al. Prognostic significance of the pattern of multivessel spasm in patients with variant angina. Jpn Circ J. 1999 Jul. 63(7):509-13. [QxMD MEDLINE Link].
Ong P, Athanasiadis A, Borgulya G, Voehringer M, Sechtem U. 3-year follow-up of patients with coronary artery spasm as cause of acute coronary syndrome: the CASPAR (coronary artery spasm in patients with acute coronary syndrome) study follow-up. J Am Coll Cardiol. 2011 Jan 11. 57(2):147-52. [QxMD MEDLINE Link].
Takagi Y, Takahashi J, Yasuda S, et al. Prognostic stratification of patients with vasospastic angina: a comprehensive clinical risk score developed by the Japanese Coronary Spasm Association. J Am Coll Cardiol. 2013 Sep 24. 62(13):1144-53. [QxMD MEDLINE Link].
Kobayashi N, Hata N, Shimura T, et al. Characteristics of patients with cardiac arrest caused by coronary vasospasm. Circ J. 2013. 77(3):673-8. [QxMD MEDLINE Link].
Hendriks ML, Allaart CP, Bronzwaer JG, Res JJ, de Cock CC. Recurrent ventricular fibrillation caused by coronary artery spasm leading to implantable cardioverter defibrillator implantation. Europace. 2008 Dec. 10(12):1456-7. [QxMD MEDLINE Link].
Figueras J, Cortadellas J, Gil CP, Domingo E, Soler JS. Comparison of clinical and angiographic features and longterm follow-up events between patients with variant angina and patients with ST elevation myocardial infarction. Int J Cardiol. 2006 Aug 10. 111(2):256-62. [QxMD MEDLINE Link].
Previtali M, Klersy C, Salerno JA, et al. Ventricular tachyarrhythmias in Prinzmetal's variant angina: clinical significance and relation to the degree and time course of S-T segment elevation. Am J Cardiol. 1983 Jul. 52(1):19-25. [QxMD MEDLINE Link].
Rosamond W. Are migraine and coronary heart disease associated? An epidemiologic review. Headache. 2004 May. 44 Suppl 1:S5-12. [QxMD MEDLINE Link].
Hirano Y, Uehara H, Nakamura H, et al. Diagnosis of vasospastic angina: comparison of hyperventilation and cold-pressor stress echocardiography, hyperventilation and cold-pressor stress coronary angiography, and coronary angiography with intracoronary injection of acetylcholine. Int J Cardiol. 2007 Apr 4. 116(3):331-7. [QxMD MEDLINE Link].
Miwa K, Kambara H, Kawai C, Murakami T. Two electrocardiographic patterns with or without transient T-wave inversion during recovery periods of variant anginal attacks. Jpn Circ J. 1983 Dec. 47(12):1415-22. [QxMD MEDLINE Link].
Miwa K, Murakami T, Kambara H, Kawai C. U wave inversion during attacks of variant angina. Br Heart J. 1983 Oct. 50(4):378-82. [QxMD MEDLINE Link]. [Full Text].
Im SI, Rha SW, Choi BG, et al. TCT-436 Association of myocardial bridge and acetylcholine dose response in patients with vasospastic angina. J Am Coll Cardiol. 2012 Oct. 60(17 Supp B):B124.
Sueda S, Miyoshi T, Sasaki Y, Sakaue T, Habara H, Kohno H. Gender differences in sensitivity of acetylcholine and ergonovine to coronary spasm provocation test. Heart Vessels. 2016 Mar. 31(3):322-9. [QxMD MEDLINE Link].
Sueda S, Kohno H, Fukuda H, et al. Clinical impact of selective spasm provocation tests: comparisons between acetylcholine and ergonovine in 1508 examinations. Coron Artery Dis. 2004 Dec. 15(8):491-7. [QxMD MEDLINE Link].
Im SI, Choi BG, Choi SY, et al. TCT-433 Impact of beta-blocker on angiographic and clinical parameters during intracoronary acetylcholine provocation test. J Am Coll Cardiol. 2012 Oct 23. 60(17 Supp B):B123.
Jang HJ, Kim TH, Kwon SW, et al. Left ventricular end diastolic pressure for detection of intracoronary ergonovine-induced myocardial ischemia. Herz. 2016 Jun. 41(4):320-5. [QxMD MEDLINE Link].
Piao ZH, Jeong MH, Li Y, et al, for the Other Korea Acute Myocardial Infarction Registry (KAMIR) Investigators. Benefit of statin therapy in patients with coronary spasm-induced acute myocardial infarction. J Cardiol. 2016 Jul. 68(1):7-12. [QxMD MEDLINE Link].
Taylor SH. Usefulness of amlodipine for angina pectoris. Am J Cardiol. 1994 Jan 27. 73(3):28A-33A. [QxMD MEDLINE Link].
Krishnan U, Win W, Fisher M. First report of the successful use of bosentan in refractory vasospastic angina. Cardiology. 2010. 116(1):26-8. [QxMD MEDLINE Link].
Yoo SY, Song SG, Lee JH, et al. Efficacy of cilostazol on uncontrolled coronary vasospastic angina: a pilot study. Cardiovasc Ther. 2013 Jun. 31(3):179-85. [QxMD MEDLINE Link]. [Full Text].
Choi BG, Jeon SY, Rha SW, et al. Impact of renin-angiotensin system inhibitors on long-term clinical outcomes of patients with coronary artery spasm. J Am Heart Assoc. 2016 Jul 21. 5(7):[QxMD MEDLINE Link].
Khitri A, Jayasuriya S, Habibzadeh MR, Movahed MR. Coronary stenting in patients with medically resistant vasospasm. Rev Cardiovasc Med. 2010 Fall. 11(4):264-70. [QxMD MEDLINE Link].
Bertrand ME, Lablanche JM, Rousseau MF, Warembourg HH Jr, Stankowtak C, Soots G. Surgical treatment of variant angina: use of plexectomy with aortocoronary bypass. Circulation. 1980 May. 61(5):877-82. [QxMD MEDLINE Link].
Lee EM, Choi MH, Seo HS, et al. Impact of vasomotion type on prognosis of coronary artery spasm induced by acetylcholine provocation test of left coronary artery. Atherosclerosis. 2017 Feb. 257:195-200. [QxMD MEDLINE Link].
Kim H, Cho SH, Cho KI, Kim BJ, Im SI, Heo JH. Blunted heart rate recovery is associated with coronary artery spasm in patients with suspected vasospastic angina. Clin Hypertens. 2017. 23:24. [QxMD MEDLINE Link].
Montone RA, Niccoli G, Fracassi F, et al. Patients with acute myocardial infarction and non-obstructive coronary arteries: safety and prognostic relevance of invasive coronary provocative tests. Eur Heart J. 2018 Jan 7. 39(2):91-8. [QxMD MEDLINE Link].
Kondo T, Terada K. Coronary-artery vasospasm. N Engl J Med. 2017 Jun 22. 376(25):e52. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

This electrocardiogram (ECG) is from a patient who underwent urgent cardiac catheterization, which revealed diffuse severe coronary spasm (most marked in the left circumflex system) without any fixed obstructive lesions. Severe left ventricular wall motion abnormalities were present, involving the anterior and inferior segments. A question of so-called takotsubo cardiomyopathy (left ventricular apical ballooning syndrome) is also raised (see Bybee et al. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Int Med 2004:141:858-65). The latter is most often reported in postmenopausal, middle-aged to elderly women in the context of acute emotional stress and may cause ST elevations acutely with subsequent T wave inversions. A cocaine-induced cardiomyopathy (possibly related to coronary vasospasm) is a consideration but was excluded here. Myocarditis may also be associated with this type of ECG and the cardiomyopathic findings shown here. No fixed obstructive epicardial coronary lesions were detected by coronary arteriography. The findings in this ECG include low-amplitude QRS complexes in the limb leads (with an indeterminate QRS axis), loss of normal precordial R wave progression (leads V1-V3), and prominent anterior/lateral T wave inversions. Image courtesy of http://ecg.bidmc.harvard.edu .

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Author

Stanley S Wang, JD, MD, MPH Clinical Cardiologist, Austin Heart South; Director of Legislative Affairs, Austin Heart; Medical Director, Sleep Disorders Center at Heart Hospital of Austin; Assistant Professor of Medicine (Adjunct), University of North Carolina School of Medicine

Stanley S Wang, JD, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, American Stroke Association, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Yasmine S Ali, MD, MSCI, FACC, FACP Assistant Clinical Professor of Medicine, Vanderbilt University School of Medicine; President, LastSky Writing, LLC

Yasmine S Ali, MD, MSCI, FACC, FACP is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Medical Writers Association, National Lipid Association, Tennessee Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: LastSky Writing;Philips Healthcare;M Health;Verywell Health; MedStudy;WellnessVerge;Prose Media; AKH, Inc.; LearnRoll, LLC; Eradigm; RxCe.com; M3 USA; M3 EU; Future US Inc.; Edanz Group; ChesterPA511<br/>Serve(d) as a speaker or a member of a speakers bureau for: RxCe.com.

Chief Editor

Eric H Yang, MD Associate Professor of Medicine, Director of Cardiac Catherization Laboratory and Interventional Cardiology, Mayo Clinic ArizonA

Eric H Yang, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Acknowledgements

Steven J Compton, MD, FACC, FACP Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals

Steven J Compton, MD, FACC, FACP is a member of the following medical societies: Alaska State Medical Association, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, and Heart Rhythm Society

Disclosure: Nothing to disclose.

Gregory J Dehmer, MD Director, Division of Cardiology, Scott & White Healthcare; Professor of Medicine, Texas A&M Health Science Center College of Medicine

Gregory J Dehmer, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, Society for Cardiac Angiography and Interventions, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

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