2017 Volume 31 Issue 1 Pages 80-86
Cervical angina is a pathological condition characterized by angina-like paroxysmal precordial pain caused by a lesion in the proximity of the cervical spine without cardiovascular abnormality. The symptom cannot be alleviated even with nitroglycerin administration. Although various reports have suggested possible causes, no report has identified the definite etiology of the disease. We report a rare case with frequent chest pain attacks, which completely disappeared after anterior cervical decompression and fusion and cervical calcified disc herniation. In addition, we compared the present case with previously reported cases.
The patient was a 78-year-old woman who complained of pain in the left chest and back area. Her symptoms worsened in August 2007. She was then hospitalized after undergoing medical examination in the emergency department, with the following results: ST segment depression (+), horizontal down-sloping V4-V6 on electrocardiography, and troponin (−). On the basis of these results, she was diagnosed as having unstable angina. Later, we conducted a cardiac catheter test and found 99-100% stenosis for #6 and 99% stenosis for #13 periphery. Percutaneous coronary intervention (PCI) for #6 was performed with a favorable collateral circulation. The patient did not have any symptoms during treadmill exercise and was discharged from the hospital. Although she repeatedly visited the emergency department every 2 or 3 months because of the pain in her left chest and back area, ischemia findings at the time of electrocardiography and blood test results were always negative. In March 2012, the symptom persisted even with PCI for #13. In June 2014, an acetylcholine prorocation test was conducted for suspected vasospastic angina, but the result was negative. As the patient occasionally had numbness and pain in both upper extremities, which worsened, she underwent a medical examination in our clinic in February 2015. Midline calcified hernia at C3/C4 and spur at C4/C5 were found on magnetic resonance imaging and computed tomographic myelography. Anterior decompression and fusion (C3/C4 and C4/C5) were conducted with a cylindrical cage in June 2015, and the postsurgical pain in the chest and back area completely resolved. A philological study showed that the affected segment often indicated symptoms associated with radiculopathy at the C6 or C7 myotome areas, but our case was considered a spinal segment disorder or sympathetic involvement.
