Relief of Refractory Angina With Vericiguat

Figures

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  Visual Summary. Refractory Vasospastic Angina With Myocardial Bridging Visual overview of a case involving refractory vasospastic angina with myocardial bridging in the proximal LAD, highlighting diagnostic findings, treatment progression, and clinical response to the off-label use of vericiguat. The summary integrates key teaching points for clinical decision-making in rare and treatment-resistant coronary syndromes. CCS = Canadian Cardiovascular Society; ECG = electrocardiogram; LAD = left anterior descending artery; LCX = left circumflex artery; sGC = soluble guanylate cyclase.

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  Figure 1. Coronary Artery Spasm Detected and Resolved Coronary angiography revealing coronary artery spasm in the LAD. (A) Right coronary artery. (B to D) Significant stenosis was detected in the proximal segment of the LAD (white arrows). (E to G) After nitroglycerin administration, the occlusion of the proximal LAD (white arrows) improved compared with baseline. LAD = left anterior descending artery.

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  Figure 2. Prevericiguat Exercise ECG Demonstrating Ischemia Exercise ECG before vericiguat treatment showing ST-segment depression of 1.0 to 1.7 mV in the inferior leads and large peaked T waves in leads V2 to V6 after exercise. ECG = electrocardiogram.

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  Figure 3. Postvericiguat Exercise ECG Showing Improvement Exercise ECG after vericiguat treatment demonstrating ST-segment depression of 1.2 to 1.4 mV in inferior leads, with ST-segment depression of 0.1 to 1.7 mV in leads V2 to V6 (improved from previous hyperacute T waves). ECG = electrocardiogram.