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DOI QR Code

Ventricular Tachycardia Associated Syncope in a Patient of Variant Angina without Chest Pain

  • Kim, Soo Jin (Department of Cardiology, Dong-A University Medical Center) ;
  • Juong, Ji Young (Department of Cardiology, Dong-A University Medical Center) ;
  • Park, Tae-Ho (Department of Cardiology, Dong-A University Medical Center)
  • Received : 2015.03.25
  • Accepted : 2015.05.27
  • Published : 2016.01.30

Abstract

A 68-year-old man was admitted for a syncope workup. After routine evaluation, he was diagnosed with syncope of an unknown cause and was discharged from the hospital. He was readmitted due to dizziness. On repeated Holter monitoring, polymorphic ventricular tachycardia was detected during syncope. We performed intracoronary ergonovine provocation test; severe coronary spasm was induced at 70% stenosis of the proximal left anterior descending artery. The patient was treated with percutaneous coronary intervention. We present a rare case of syncope induced by ventricular arrhythmia in a patient with variant angina without chest pain.

Keywords

References

  1. 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;27:375-88. https://doi.org/10.1016/0002-9343(59)90003-8
  2. Kusama Y, Kodani E, Nakagomi A, et al. Variant angina and coronary artery spasm: the clinical spectrum, pathophysiology, and management. J Nippon Med Sch 2011;78:4-12. https://doi.org/10.1272/jnms.78.4
  3. Kishida H, Tada Y, Fukuma N, Saitoh T, Kusama Y, Sano J. Significant characteristics of variant angina patients with associated syncope. Jpn Heart J 1996;37:317-26. https://doi.org/10.1536/ihj.37.317
  4. Yasue H, Takizawa A, Nagao M, et al. Long-term prognosis for patients with variant angina and influential factors. Circulation 1988;78:1-9. https://doi.org/10.1161/01.CIR.78.1.1
  5. Lanza GA, Sestito A, Sgueglia GA, et al. Current clinical features, diagnostic assessment and prognostic determinants of patients with variant angina. Int J Cardiol 2007;118:41-7. https://doi.org/10.1016/j.ijcard.2006.06.016
  6. European Heart Rhythm Association, Heart Rhythm Society, Zipes DP, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death). J Am Coll Cardiol 2006;48:e247-346. https://doi.org/10.1016/j.jacc.2006.07.010
  7. Myerburg RJ, Kessler KM, Mallon SM, et al. Life-threatening ventricular arrhythmias in patients with silent myocardial ischemia due to coronary-artery spasm. N Engl J med 1992;326:1451-5. https://doi.org/10.1056/NEJM199205283262202
  8. Postorino C, Gallagher MM, Santini L, et al. Coronary spasm: a case of transient ST elevation and syncopal ventricular tachycardia without angina. Europace 2007;9:568-70. https://doi.org/10.1093/europace/eum087
  9. Yoo SY, Shin DH, Jeong JI, et al. Long-term prognosis and clinical characteristics of patients with variant angina. Korean Circ J 2008;38:651-8. https://doi.org/10.4070/kcj.2008.38.12.651
  10. Chin A, Casey M. Variant angina complicated by polymorphic ventricular tachycardia. Int J Cardiol 2010;145:e47-9. https://doi.org/10.1016/j.ijcard.2008.12.138
  11. Tanabe Y, Itoh E, Suzuki K, et al. Limited role of coronary angioplasty and stenting in coronary spastic angina with organic stenosis. J Am Coll Cardiol 2002;39:1120-6. https://doi.org/10.1016/S0735-1097(02)01746-1
  12. Gaspardone A, Tomai F, Versaci F, et al. Coronary artery stent placement in patients with variant angina refractory to medical treatment. Am J Cardiol 1999;84:96-8, A8. https://doi.org/10.1016/S0002-9149(99)00201-5
  13. Berntsen RF, Gunnes P, Lie M, Rasmussen K. Surgical revascularization in the treatment of ventricular tachycardia and fibrillation exposed by exercise-induced ischaemia. Eur Heart J 1993;14:1297-303. https://doi.org/10.1093/eurheartj/14.10.1297
  14. Matsue Y, Suzuki M, Nishizaki M, Hojo R, Hashimoto Y, Sakurada H. Clinical implications of an implantable cardioverter-defibrillator in patients with vasospastic angina and lethal ventricular arrhythmia. J Am Coll Cardiol 2012;60:908-13. https://doi.org/10.1016/j.jacc.2012.03.070

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  1. Prinzmetal angina. Questions of pathogenesis, clinic, diagnosis and treatment vol.91, pp.11, 2016, https://doi.org/10.26442/00403660.2019.11.000107