The challenges of treating acute myocardial infarction due to variant angina

November 19, 2020

In a new publication from Cardiovascular Innovations and Applications; DOI, Wen-Yuan Ding, Jia-Min Li, Fei Zheng, Li-Li Wang, Xin-Yi Wei and Guo-Hua Li from Shandong Provincial Qianfoshan Hospital, Ji'nan, China, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji'nan, China and Shandong First Medical University, Tai'an, China consider the challenges of treating acute myocardial infarction due to variant angina.

Coronary spasm plays an important part not only in the pathogenesis of variant angina (VA) but also in ischemic disease generally, including resting and effort angina, acute myocardial infarction (AMI), and sudden death. In approximately one in ten patients with AMI, angiography does not reveal any obstructive coronary artery disease. VA is characterized by chest pain that is not related to exercise and is frequently accompanied by transient ST segment elevation on ECG. The patient is symptom-free with normal ECG findings during the symptom-free periods. Although the underlying mechanism is not well understood, it appears to involve a combination of endothelial damage and vasoactive mediators.

In this case study, a 58-year-old man with myocardial infarction secondary to coronary artery vasospasm experienced recurrent chest pain and had a noncritical lesion as revealed by a normal coronary angiogram. The patient was treated with diltiazem. Diltiazem is a non-dihydropyridine CCB. CCBs seem to be the first-line therapy for VA. Nitrates were also found to be efficient therapy. Clinical trials have revealed that patients who received diltiazem have better outcomes than patients treated with other medical therapy. Diltiazem inhibits mainly L-type calcium channels. Diltiazem can reduce arterial wall injury caused by calcium overload, inhibit smooth muscle proliferation and arterial matrix protein synthesis, increase vascular compliance, inhibit lipid peroxidation, and protect endothelial cells.

This case provides information about the treatment with diltiazem of patients with AMI secondary to VA. VA can be life-threatening. Since the patient positively responded to the therapy, he was followed up without further intervention and did not have an additional episode of VA during a 3-month period of follow-up.
Citation information: The Challenges of Treating Acute Myocardial Infarction due to Variant Angina Wen-Yuan Ding, Jia-Min Li, Fei Zheng, Li-Li Wang, Xin-Yi Wei and Guo-Hua Li, Cardiovasc. Innov. App., 2020,

Keywords: Variant angina; coronary spasm; transient ST segment changes; coronary angiography; troponin levels; calcium channel blockers

CVIA is available on the IngentaConnect platform and at Cardiovascular Innovations and Applications. Submissions may be made using ScholarOne Manuscripts. There are no author submission or article processing fees. CVIA is indexed in the EMBASE, ESCI, OCLC, Primo Central (Ex Libris), Sherpa Romeo, NISC (National Information Services Corporation), DOAJ and Index Copernicus Databases. Follow CVIA on Twitter @CVIA_Journal; or Facebook.

Compuscript Ltd

Related Chest Pain Articles from Brightsurf:

New approach helps EMTs better assess chest pain en route to hospital
A study conducted at Wake Forest Baptist Health shows that on-scene use of a new protocol and advanced diagnostic equipment can help paramedics better identify patients at high risk for adverse cardiac events.

Brain activity during psychological stress may predict chest pain in people with heart disease
The brain's reaction to stress could be an important indicator of angina (chest pain) among people with known heart disease.

Chest pain, stress tests warrant attention even if arteries are clear
Patients who experience chest pain and have abnormal results on a cardiac stress test but who do not have blocked arteries often experience changes in their symptoms and stress test results over time, according to research presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

Women carry heavier burden of chest pain, but less artery narrowing
Women with coronary artery disease that reduces blood flow and oxygen to the heart muscle (ischemia) have significantly more chest pain caused by plaque build-up, yet less extensive disease as compared with men, according to new research presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

More isn't better when it comes to evaluating chest pain
New and more effective tests are needed to help predict heart attacks and other major cardiac events in patients with chest pain, the second most common reason for emergency department visits in the US.

Artificial intelligence could prevent unneeded tests in patients with stable chest pain
Artificial intelligence (AI) could prevent unnecessary diagnostic tests in patients with stable chest pain, according to research presented today at ICNC 2019.

Kaiser Permanente improves emergency care for patients with chest pain
Emergency physicians at Kaiser Permanente hospitals in Southern California reduced hospital admissions and cardiac stress testing by using new criteria to assess the level of risk patients with chest pain have for subsequent cardiac events.

Treatment for underdiagnosed cause of debilitating chest pain
Researchers find an effective way to treat an underdiagnosed condition that can cause heart attack and heart-attack-like symptoms.

Diagnostic protocol effective in identifying ED patients with acute chest pain
A relatively new accelerated diagnostic protocol is effective in identifying emergency department patients with acute chest pain who can be safely sent home without being hospitalized or undergoing comprehensive cardiac testing, according to researchers at Wake Forest Baptist Medical Center.

Chest pain drug falls short in preventing first episode of ventricular arrhythmia or death
A trial of more than 1,000 patients with implantable cardioverter defibrillators found that the drug ranolazine (used to treat chest pain; brand name Ranexa®) was safe but didn't decrease the likelihood of the first occurrence of ventricular arrhythmias or death in this high-risk population.

Read More: Chest Pain News and Chest Pain Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to