Name of the Procedure:

Ergonovine Provocation Test (also known as Ergometrine Test, or Ergonovine Stress Test)

Summary

The Ergonovine Provocation Test is a diagnostic procedure used to provoke coronary artery spasms by administering a medication called ergonovine. This helps doctors determine if a patient has a condition known as Prinzmetal’s angina or variant angina.

Purpose

The procedure aims to identify coronary artery spasms that may not be detected by other methods. The primary goal is to diagnose Prinzmetal’s angina, which can cause intermittent chest pain.

Indications

• Recurrent chest pain not explained by other testing.
• Suspected Prinzmetal’s angina.
• Evaluation of unexplained coronary artery spasms.

Preparation

• Patients are instructed to fast for 4-6 hours before the test.
• Certain medications, especially those affecting heart rhythms or blood pressure, may need to be paused as advised by the doctor.
• A thorough medical evaluation and discussion of the patient's history and symptoms.

Procedure Description

1. The patient is connected to an electrocardiogram (ECG) to monitor heart activity.
2. A healthcare provider inserts an intravenous (IV) line.
3. Baseline heart activity and blood pressure are recorded.
4. Ergonovine is administered through the IV in small, incremental doses.
5. Continuous monitoring of the heart's response through ECG.
6. If a coronary spasm is detected, nitroglycerin may be administered to relieve the spasm.
7. The test is stopped once sufficient diagnostic information is obtained or symptoms are provoked.

Duration

The entire procedure typically takes about 30 to 60 minutes.

Setting

The test is usually performed in a hospital setting, specifically in a cardiac catheterization lab or a controlled medical environment with immediate access to emergency care.

Personnel

The test is conducted by a cardiologist with support from a nurse or other trained healthcare professionals.

Risks and Complications

• Induced coronary artery spasm.
• Chest pain or discomfort.
• Arrhythmias (irregular heartbeats).
• Rarely, heart attack or other serious complications.
• Management involves immediate cessation of ergonovine and use of medications like nitroglycerin.

Benefits

• Accurate diagnosis of Prinzmetal's angina.
• Identification of otherwise undetectable coronary spasms.
• Guides appropriate treatment strategies for better management of symptoms.

Recovery

• Patients are monitored for a short period post-procedure.
• Normal activities can usually be resumed shortly afterward.
• Follow-up appointments may be scheduled to discuss results and further management.

Alternatives

• Non-invasive stress tests (less definitive for coronary spasm).
• Ambulatory ECG monitoring (Holter monitor).
• Coronary angiography (for structural assessment).
• Pros and cons include varying degrees of invasiveness, accuracy, and suitability based on patient condition.

Patient Experience

• Some discomfort from IV insertion and administration of medication.
• Possible transient chest pain or tightness.
• Continuous support and monitoring to ensure safety and address any discomfort promptly.
• Pain management includes immediate intervention with nitroglycerin if needed.