most patients with vasospastic diathesis do not develop any disease.
An 85-year-old previously healthy woman with symptomatic complete atrioventricular block, baseline QRS duration 166 ms, slow ventricular escape rhythm and normal ventricular systolic function underwent successful dual-chamber permanent pacemaker implantation with right ventricular (RV) apical (RVA) lead placement. One week later, plasma B-type natriuretic peptide (BNP) increased from 260 to 1,020 pg/ml, and cardiothoracic ratio was increased on chest X-ray (63%>59%). In addition, echocardiography showed new left ventricular (LV) wall motion abnormalities involving the mid and apical segments despite lack of serial change on 12-lead electrocardiogram (ECG) under ventricular pacing, or creatine phosphokinase elevation. Coronary angiography showed normal coronary arteries without vasospastic diathesis, while the left ventriculogram showed apical ballooning (). Cine magnetic resonance imaging (MRI) also showed apical ballooning (), and resting 201Tl myocardial scintigraphy showed fixed perfusion defects at the LV apex, inferior and posterior wall (). Late gadolinium-enhanced MRI (LGE-MRI) indicated subendocardial late gadolinium enhancement at the apex, which was much smaller than the extent of apical ballooning, without myocardial edema on black-blood T2-weighted imaging ().
G6PD deficiency, under 18 years old, vasospastic diathesis (e.g
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Gasser et al., reported that patients with vasospastic disorders often had visual field defects. While Guthauser et al., observed that such visual field defects could be provoked by cold and improved by calcium channel blockers in patients with vasospastic diathesis but not in normals.
25/11/2015 · View Details Figure 1
(A) Coronary angiography showed normal coronary arteries without vasospastic diathesis, while left ventriculogram showed apical ballooning. (B, Top) Black-blood T2-weighted imaging in 4-chamber view and 2-chamber view showed apical ballooning with slow flow artifact, but myocardial edema was not detected. (B, Bottom) Corresponding late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) showed subendocardial scar at the apical ballooning (red arrows).