Virtual Conference
Heart 2022 Conference

Samuel Ferreira Dias da Silva

Universidade Nove de Julho, Brazil

Title: Vasospastic angina difficult to control


Background: Vasospastic angina (VSA) is a variant form of angina pectoris, in which angina occurs at rest, with transient electrocardiographic changes and preserved exercise capacity. Is a challenging clinical entity, deserving attention for its diagnosis and correct management. 

Case: Patient, female, 47 years old. Report of chest pain and palpitations since the age of 30 years. She was hospitalized for having presented two cardiorespiratory arrests preceded by typical precordial pain of severe intensity and referred to a cardiology referral center for evaluation. Physical examination, electrocardiogram (ECG), magnetic resonance imaging and transthoracic echo showed no changes. 24h Holter with evidence of ST-segment depression related to an increase in heart rate compatible with ischemia. She presented with typical chest pain of severe intensity and was referred for catheterization. Admitted to hemodynamics with pain and ECG with elevation in DII, DIII and aVF. Coronary angiography, evidence of three-vessel spasm, reversed after the use of intracoronary nitroglycerin. Seen irregularities in the right and circumflex coronary arteries, with a 30% lesion in the anterior descending. 

Discussion: Patient was discharged from hospital with adjustment of calcium channel blockers (BCC). On an outpatient return visit, she was symptomatic, had daily functional class III angina and went to emergency units, which had an impact on her quality of life, but without ischemia or myocardial injury by ECG or laboratory tests. Thus, attempts were made to adjust medication with BCC, long-acting and short-acting nitrate, trimetazidine. It was re-evaluated and due to the maintenance of angina, it was decided to associate an alpha-blocker (tamsulosin). After the association, he reported improvement in symptoms, with a reduction in the frequency of anginal episodes, with no need to go to the emergency room. 

Conclusion: In general, the treatment of vasospastic angina should be guided by patient-specific factors, such as tolerability, adverse effects, and drug interactions. The use of alpha-blockers may be an option given the pathophysiology of the disease.


Samuel Ferreira Dias da Silva is a medical student from Brazil.