Vasospastic angina (VSA) was first described in 1959 by Myron Prinzmetal as \"the variant form of angina pectoris\" on the sole basis of medical history and ECG. This condition is currently categorized as an endotype of myocardial infarction without coronary obstruction (Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA)). Diagnostic criteria have been suggested by expert consensus. Provocative testing during coronary angiography is the gold standard test but is rarely used. The clinical presentation is often neglected, and the diagnosis is missed. However, VSA may lead to life-threatening arrhythmias. There are simple and effective therapies that are markedly different from those for the atherosclerotic coronary artery disease.
Le vasospasme coronarien (VC) a été décrit pour la première fois en 1959 par Myron Prinzmetal comme « la forme variante de l’angine de poitrine » sur la seule base de l’anamnèse et de l’ECG. Le VC est actuellement classé comme un endotype de l’infarctus du myocarde sans obstruction coronaire (Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA)). Des critères diagnostiques ont été proposés par des consensus d’experts. Le test de provocation lors de la coronarographie est l’examen de choix mais est rarement employé. La symptomatologie est souvent méconnue et le diagnostic n’est pas suffisamment évoqué. Pourtant, le VC peut conduire à des arythmies potentiellement fatales. Nous disposons de moyens thérapeutiques simples et efficaces, qui diffèrent sensiblement de ceux de la maladie coronarienne athérosclérotique.

Coronary vasospasm can lead to decreased cardiac perfusion and result in acute coronary syndrome. Here is a case of a 49-year-old man presented to the emergency department with epigastric pain and nausea with normal initial electrocardiogram. However, 6 h later, the patient experienced severe chest pain prompting a repeat electrocardiogram demonstrating inferior ST-segment elevation with troponin I levels peaked at 1.2 ng/ml (normal range: 0.00-0.02 ng/ml). Coronary angiography revealed angiographic stenosis in the left circumflex territory of a left dominant system which resolved with intracoronary nitroglycerin administration indicating ischemia with nonobstructive coronary arteries secondary to coronary vasospasm. He was discharged on isosorbide mononitrate and amlodipine therapy and had no recurrence of symptoms during follow-up.
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UNASSIGNED: Coronary vasospasm (CVS) is a common cardiovascular condition, yet its implications should not be underestimated. Regrettably, the current diagnostic and treatment standards for CVS in China are not standardized, severely affecting the quality of life for patients with this condition.
UNASSIGNED: A 68-year-old male presented to the hospital one month prior due to recurrent chest pain. Coronary angiography (CAG) revealed a mid-segment muscle bridge with plaque formation in the left anterior descending artery, followed by pharmacological balloon angioplasty. The primary diagnosis post-operation was acute non-ST elevation myocardial infarction (NSTEMI) and coronary artery myocardial bridging. This time, the patient experienced nocturnal chest pain with a dynamic increase in troponin levels. Emergency CAG showed the left anterior descending and right coronary arteries were fine, with segmental narrowing reaching 95%-99%. Intravascular ultrasound (IVUS) indicated negative remodeling of the mid-segment lumen associated with myocardial bridging, with the smallest lumen area being 2.19 mm2. After intracoronary administration of nitroglycerin, the original most narrowed lumen area increased to 8.81 mm2. Consequently, a definitive diagnosis of CVS with coronary artery myocardial bridging was made, and the medication treatment plan was promptly adjusted. The patient\'s symptoms disappeared, and he was discharged. Follow-up after more than three months showed no recurrence of symptoms.
UNASSIGNED: In cases where provocative agents are contraindicated, CAG combined with IVUS can optimize the differential diagnosis of CVS. There is an urgent need in China to improve epidemiological data on CVS and establish standardized diagnostic and treatment protocols.

Acute viral myocarditis and hyperthyroidism can present with acute coronary syndrome. However, the link between hyperthyroidism and myocarditis has hardly been explored apart from a small collection of published case reports. We report a case where a patient presents with severe chest pain and was found to have concomitant severe coronary vasospasm and acute myocarditis and was diagnosed with Graves\' disease.

BACKGROUND: Coronary vascular dysfunction comprises VSA and/or MVA and is more common in women than in men with angina without obstructive coronary artery disease (ANOCA). Invasive coronary function testing is considered the reference test for diagnosis, but its burden on patients is large. We aimed to investigate the potential of electrocardiography (ECG) as noninvasive marker for vasospastic angina (VSA) and microvascular angina (MVA) diagnosis.
METHODS: We systematically screened Pubmed and EMBASE databases for studies reporting on ECG characteristics in ANOCA patients with (a suspicion of) coronary vascular dysfunction. We assessed study quality using QUADAS-2. We extracted data on diagnostic values of different ECG characteristics and analyzed whether the studies were sex-stratified.
RESULTS: Thirty publications met our criteria, 13 reported on VSA and 17 on MVA. The majority addressed repolarization-related ECG parameters. Only 1 of the 13 VSA papers and 4 of the 17 MVA papers showed diagnostic accuracy measures of the ECG characteristics. The presence of early repolarization, T-wave alternans, and inverted U waves showed of predictive value for VSA diagnosis. The QTc interval was predictive for MVA diagnosis in all six studies reporting on QTc interval. Sex-stratified results were reported in only 5 of the 30 studies and 3 of those observed sex-based differences.
CONCLUSIONS: ECG features are not widely evaluated in diagnostic studies for VSA and MVA. Those features predictive for VSA and MVA diagnosis mostly point to repolarization abnormalities and may contribute to noninvasive risk stratification.

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BACKGROUND: Vasoreactivity testing, such as intracoronary acetylcholine (ACh) or ergometrine (EM), is defined as Class I for the diagnosis of patients with vasospastic angina (VSA) according to recommendations from the Coronary Vasomotion Disorders International Study (COVADIS) group and guidelines from the Japanese Circulation Society (JCS).
OBJECTIVE: Although vasoreactivity testing is a clinically useful tool, it carries some risks and limitations in diagnosing coronary artery spasm.
METHODS: Previous reports on vasoreactivity testing for diagnosing the presence of coronary spasm are summarized from the perspective of Class I.
RESULTS: There are several problems such as reproducibility, underestimation, overestimation, and inconclusive/nonspecific results associated with daily spasm. Because provoked spasm caused by intracoronary ACh is not always similar to that caused by intracoronary EM, possibly due to different mediators, supplementary use of these vasoreactivity tests is necessary for cardiologists to diagnose VSA when a provoked spasm is not revealed by each vasoactive agent.
CONCLUSIONS: Cardiologists should understand the imperfection of these vasoreactivity tests when diagnosing patients with VSA.

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Ischemic heart disease (IHD) is common in women, and cardiovascular disease is a leading cause of morbidity and mortality. While obstructive coronary artery disease is the most common form of IHD, millions of women suffer from angina with nonobstructive coronary arteries (ANOCA), an umbrella term encompassing multiple nonatherosclerotic disorders of the coronary tree. The underlying pathology leading to ischemia in these syndromes may be challenging to diagnose, leaving many women without a diagnosis despite persistent symptoms that impact quality of life and adversely affect long-term cardiovascular prognosis. In the last decade, there have been significant advances in the recognition and diagnostic evaluation of ANOCA. Despite these advances, the standard approach to evaluating suspected IHD in women continues to focus predominantly on the assessment of atherosclerotic coronary artery disease, leading to missed opportunities to accurately diagnose and treat underlying coronary vasomotor disorders. The goal of this review is to describe advances in diagnostic testing that can be used to evaluate angina in women and present a pragmatic diagnostic algorithm to guide evaluation of ANOCA in symptomatic patients. The proposed approach for the assessment of ANOCA is consistent with prior expert consensus documents and guidelines but is predicated on the medical interview and pretest probability of disease to inform a personalized diagnostic strategy.

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