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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 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