PROLONGED SPASM OF THE LEFT ANTERIOR DESCENDING CORONARY ARTERY (case report) Kulić M., Mujičić...

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 SarajevoCardiology 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

• Definition

• Pathophysiology

• Frequency

• Treatment

• Case report

• Conclusion2Kulić M, Mujičić E, Šošević A et

al. Prolonged spasm of the LAD

DEFINITION

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

3Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

PATHOPHYSIOLOGY

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

4Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

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

5Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

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.

6Kulić M, Mujičić E, Šošević A et al.

Prolonged spasm of the LAD

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

7Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

MEDICAL THERAPY

• Nitrates

• Calcium channel blockers (CCBs)

• Statins

8Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

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

9Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

SADA PRIKAZATI EKG 2007/2008

11Kulić M, Mujičić E, Gorani D et al. Prolonged spasm of the LAD

EKG 2009.

Exercise tolerance testwas characteristically normal

• slika ergometrije

CASE REPORT

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

• She was planed for MSCT or for coronary angiography

14Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

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

15Kulić 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

• 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