Teragawa H, Fujii Y, Uchimura Y, Ueda T. Importance of a second spasm provocation test: Four cases with an initial negative spasm provocation test. World J Cardiol 2017; 9(3): 289-295 [PMID: 28400927 DOI: 10.4330/wjc.v9.i3.289]
Corresponding Author of This Article
Hiroki Teragawa, MD, PhD, Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima 732-0057, Japan. hiroteraga71@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hiroki Teragawa, Yuichi Fujii, Yuko Uchimura, Tomohiro Ueda, Department of Cardiovascular Medicine, JR Hiroshima Hospital, Higashi-ku, Hiroshima 732-0057, Japan
Author contributions: Teragawa H wrote the manuscript; Fujii Y, Uchimura Y and Ueda T collected and evaluated the data.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at JR Hiroshima Hospital.
Informed consent statement: The patients involved in this study gave written informed consent authorizing use and disclosure of their protected health information.
Conflict-of-interest statement: All authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hiroki Teragawa, MD, PhD, Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima 732-0057, Japan. hiroteraga71@gmail.com
Telephone: +81-82-2621171 Fax: +81-82-2621499
Received: August 28, 2016 Peer-review started: August 30, 2016 First decision: September 27, 2016 Revised: October 28, 2016 Accepted: January 11, 2017 Article in press: January 14, 2017 Published online: March 26, 2017
Abstract
The spasm provocation test (SPT) is an important test in the diagnosis of vasospastic angina (VSA). In many cases, this test is performed as the gold standard test, and VSA is considered not present if the SPT is negative. However, some patients continue to experience chest symptoms despite a negative SPT. In this study, we report four cases in which SPT was repeated to evaluate chest symptoms despite the negative results of the first SPT. Two men in their 70s, one woman in her 60s, and one woman in her 70s, all with chest symptoms, underwent a second SPT at 4, 3, 2, and 3 years, respectively, after the first SPT, which was negative. Three patients had positive results in the second SPT (75%). In conclusion, even when SPT is negative, the diagnosis of VSA should be made with clinical symptoms in consideration. In some cases, a second SPT may be required to confirm the diagnosis of VSA.
Core tip: The spasm provocation test (SPT) is an important examination when diagnosing vasospastic angina (VSA). In general, if the SPT is negative, VSA is considered not present. However, we encountered four patients who underwent a second SPT although the first SPT was negative. In these patients, some show a positive second SPT result. SPT is not a perfect examination, and in the clinical setting, the diagnosis of VSA should be made with the consideration of their clinical symptoms and examinations.
