Prolonged spasm of the left anterior descending coronary artery case report
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PROLONGED SPASM OF THE LEFT ANTERIOR DESCENDING CORONARY ARTERY (case report). Kulić M., Mujičić E., Šošević A., Gorani D.*, Tahirović E., Spužić M. Heart center, KCU Sarajevo Cardiology Clinic, KC Priština*. SPASM OF THE CORONARY ARTERY. Definition Pathophysiology F requency

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Prolonged spasm of the left anterior descending coronary artery case report

PROLONGED SPASM OF THE LEFT ANTERIOR DESCENDING CORONARY ARTERY(case report)

Kulić M., Mujičić E., Šošević A.,

Gorani D.*, Tahirović E., Spužić M.

Heart center, KCU Sarajevo

Cardiology Clinic, KC Priština*

5th Congress of Cardiologists and Angiologists of Bosnia and Herzegovina Sarajevo, 27-29 May, 2010,.Hotel Radon Plaza


Spasm of the coronary artery
SPASM OF THE CORONARY ARTERY

  • Definition

  • Pathophysiology

  • Frequency

  • Treatment

  • Case report

  • Conclusion

Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Definition
DEFINITION

  • In 1959, Prinzmetal et al described a syndrome of chest pain at restassociated with ST-segment elevation

Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Pathophysiology
PATHOPHYSIOLOGY

  • Coronary spasm is caused primarily by vascular smooth muscle cell hypercontraction

Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Pa thophysiolo gy
PATHOPHYSIOLOGY

  • Abnormalities of NO production

  • Activated platelets - releases thromboxane A2

  • Low levels of intracellular magnesium and vitamin E as well.

  • Hyperinsulinemia and insulin resistance are probable risk factors for variant angina

Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Frequency
FREQUENCY

  • 2-3% of all patients undergoing diagnostic cardiac catheterization in the USA

  • In Italy, the incidence of variant angina is approximately 10%.

  • A Japanese type of variant angina (termed vasospastic angina) with 20-30% of patients who undergo coronary angiography.

Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Diagnosis
DIAGNOSIS

  • A 12-lead electrocardiograph should be repeated with each episode of chest pain

  • Serial cardiac enzyme assays

  • Holter monitoring

  • Exercise tolerance test

  • Thallium scintigraphy

  • Coronary angiography

Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Medical therapy
MEDICAL THERAPY

  • Nitrates

  • Calcium channel blockers (CCBs)

  • Statins

Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Case report
CASE REPORT

  • 39-year old female patient

  • chest pain since february 2007.

  • EKG- SR, fr.: 75/min., neg T in D3, aVF, V1-V3

  • RR: 120/80mmHg., P: 75/min

  • Lab exam: without abnormalities

Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Sada prikazati ekg 2007 2008
SADA PRIKAZATI EKG 2007/2008

Kulić M, Mujičić E, Gorani D et al. Prolonged spasm of the LAD



Exercise tolerance test was characteristically normal
Exercise tolerance testwas characteristically normal

  • slika ergometrije


Case report1
CASE REPORT

  • Echocardiography was also normal with EF: 72%, without valvular abnormalities

  • She was planed for MSCT or for coronary angiography

Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Case report2
CASE REPORT

  • Patient desided to performe directly coronary angiogram without MSCT

  • Patient came from Montenegro in our cath.lab

  • She also demanded coronary angiography by radial approach

Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Conclusion
Conclusion

  • Spasm of coronary arteries is sometimes a life-threatening condition

  • The complete team, consisting of interventional cardiologist, intensivist/anesthesiologist and others, is necessery to be preasent for positive outcome of tretment of these patients.

Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD


Thank you


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