Calcium channel blockers effective for pregnant patient with vasospastic angina: Case study

Written By :  Dr. Kamal Kant Kohli
Published On 2023-12-08 23:00 GMT   |   Update On 2023-12-08 23:00 GMT
Advertisement

Japan: Treatment with a calcium channel blocker in a woman diagnosed with severe vasospastic angina (VSA) led her to carry a healthy baby to full term without angina attacks, a recent case study has shown. The case was published in a special Cardio-Obstetrics issue of JACC: Case Reports. 

Her pregnancy progressed without VSA symptoms after the second trimester and there were no signs of abnormal development of the fetus. After delivery, the patient continued treatment with no recurrence of symptoms and the child obtained no disabilities.

Vasospastic angina is an abnormality of the coronary artery. It presents as chest pain that is caused by coronary artery spasm. It can result in recurrent episodes of angina, including at rest, and can progress into coronary microvascular dysfunction, acute myocardial infarction, ventricular arrythmias and even sudden cardiac death. VSA can be triggered during pregnancy when hormonal and nervous system changes occur.

This case presents a patient with no medical history who was in the process of trying to conceive. VSA is often overlooked in patients presenting with chest pain but can result in acute myocardial infarction (heart attack) in pregnant women. Due to its risks to pregnancy, clinicians need to make a definitive diagnosis of VSA, determine its severity and provide proper treatment.

People with VSA are usually treated with calcium channel blockers, however, there is some concern about their safety when prescribed to pregnant people.

“Pregnant patients with vasospastic angina may require special management,” said Kota Murai, MD, Ph.D., a cardiologist at the Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan and an author of the study. “Clinicians must be able to accurately assess the advantages and disadvantages of certain VSA treatments and determine which is most beneficial to the health of both the mother and child. This case offers clear evidence of the advantages of the careful management of calcium channel blockers for people who are pregnant or trying to get pregnant.”

Calcium channel blockers are under speculation for pregnant patients due to reports of teratogenicity in animal studies. They are unlicensed for use in pregnancy in many countries. However, study authors conclude that calcium channel blockers-such as diltiazem-should be considered under certain conditions. Conditions include prior consultation with the patient, family, obstetricians and cardiologists, invasive catheterization and testing.

To achieve the patient’s diagnosis and determine perinatal cardiovascular risk, doctors performed invasive coronary catheterization and vasospasm provocation testing, which resulted in sub-occlusion in the left main trunk (LMT) with chest pain, ST segment depression in the V4-6 leads and hypotension. She was then administered an infusion of isosorbide mononitrate and nicorandil, which alleviated her symptoms. After testing, the patient was confirmed to have severe vasospastic angina and was administered a calcium channel blocker.

The patient was prescribed Diltiazem 200 mg daily and successfully conceived shortly after treatment. The effectiveness of diltiazem was confirmed when she experienced chest pain after treatment was temporarily discontinued due to hyperemesis gravidarum.

Her pregnancy progressed without VSA symptoms after the second trimester and there were no signs of abnormal development of the fetus. After delivery, the patient continued treatment with no recurrence of symptoms and the child obtained no disabilities.

Tags:    
Article Source : JACC Case Reports

Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.

NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.

Our comments section is governed by our Comments Policy . By posting comments at Medical Dialogues you automatically agree with our Comments Policy , Terms And Conditions and Privacy Policy .

Similar News