Increased frequency of angina attacks caused by switching a brand-name vasodilator to a generic vasodilator in patients with vasospastic angina: Two case reports

Figure 1 Coronary angiography and spasm provocation test (SPT) for Case 1. Coronary angiograms show angiographically normal coronary arteries (left upper and lower panels). During the SPT, coronary spasms occurred at the distal segment of the right coronary artery (RCA) at 50 μg of ACh (middle upper panel) and at the mid-segment of the left anterior descending coronary artery (LAD) at 30 μg of ACh (middle lower panel). These coronary spasms resolved after an injection of nitroglycerin (right upper and lower panels). Spastic segments are indicated by arrows.

Figure 2 Coronary angiography and SPT for Case 2. Coronary angiograms show no significant coronary stenosis of either the RCA (left upper panel) or the left circumflex artery (LCA, left lower panel). The SPT performed during treatment with several vasodilator showed coronary spasms at the distal segments of the RCA at a dose of 30 μg ACh (middle upper panel), distal to the stented segment of the LAD and at the diffuse segment of the LCA (middle lower panel). These coronary spasms resolved immediately after an injection of nitroglycerin (right upper and lower panels). Spastic segments are indicated by arrows.