scholarly journals Vasospastic angina pectoris complicated by acute myocardial infarction and complete atrioventricular block

2011 ◽  
Vol 68 (7) ◽  
pp. 611-615
Author(s):  
Milan Pavlovic ◽  
Goran Koracevic ◽  
Snezana Ciric-Zdravkovic ◽  
Nebojsa Krstic ◽  
Aleksandar Stojkovic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Spasm ◽  
Myocardial Necrosis ◽  
Middle Part ◽  
Cold Weather ◽  
Vasospastic Angina ◽  
St Segment Elevation ◽  
St Segment ◽  
Retrosternal Pain ◽  
Vasospastic Angina Pectoris

Background. A prolonged coronary artery spasm with interruption of coronary blood flow can lead to myocardial necrosis and increase of cardiospecific enzymes and can be complicated with cardiac rhythm disturbances, syncopc, or even sudden cardiac death. Case report. A 55-year old male felt a severe retrosternal pain when exposing himself to cold weather. The pain lasted for 20 minutes and was followed by the loss of conscience. Electrocardiogram (ECG) showed a complete antrioventricular (AV) block with nodal rhythm and marked elevation of ST segment in inferior leads. Electrocardiogram was soon normalized, but serum activities of cardiospecific enzymes were increased. Coronarography showed normal findings for the left coronary artery and a narrowing at the middle part of the right coronary artery, which disappeared after intracoronary application of nitroglycerine. The following therapy was prescribed: Diltiazem, Amlodipin, Isosorbid mononitrate, Molisdomin, Atrovastatin, Aspirin and Nitroglycerine spray. After 7 months medicaments were abandoned and the patient experienced again reccurent chest pain episodes at rest. Transitory ST segment elevation was recorded in inferior leads of ECG, but without increase of cardiospecific enzymes serum activities. After restoration of the medicament therapy anginal episodes ceased. Conclusion. Coronary dilators in maximal doses can prevent attacks of vasospastic angina.

scholarly journals Recurrent Coronary Artery Spasm Induced by Vasopressors During Two Operations in the Same Patient Under General Anesthesia

2018 ◽  
Vol 65 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Naotaka Kishimoto ◽  
Munenori Kato ◽  
Yasunori Nakanishi ◽  
Akari Hasegawa ◽  
Yoshihiro Momota
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
General Anesthesia ◽  
Computed Tomography Angiography ◽  
Coronary Artery Spasm ◽  
Variant Angina ◽  
St Segment Elevation ◽  
Know How ◽  
St Segment

Variant angina is caused by coronary artery spasm (CAS) with ST-segment elevation. We herein report a case of recurrent CAS during 2 operations in the same patient. An 80-year-old woman was scheduled to undergo tracheostomy, submandibular dissection, left partial maxillectomy, and coronoidectomy. We administered ephedrine and phenylephrine to manage hypotension during general anesthesia. Immediately after the administration of these drugs, the ST segment elevated. We decided to cease the operation and transport the patient to the department of cardiology. Computed tomography angiography revealed pneumomediastinum. The cardiologists considered that the electrocardiography findings had changed secondary to pneumomediastinum. About 6 weeks later, a second operation was scheduled. We administered ephedrine and phenylephrine to manage hypotension during general anesthesia. Immediately after the administration of these drugs, ST-segment elevation occurred. We discontinued use of these drugs, and the ST-segment elevation did not recur. We considered that the cause of the ST-segment elevation was vasopressor-induced CAS because the vasopressors were administered immediately before the occurrence of CAS. Vasopressors such as ephedrine or phenylephrine are frequently used to manage hypotension during general anesthesia. Therefore, anesthesiologists should consider the occurrence of CAS before using vasopressors and know how to manage CAS well.

scholarly journals Comparison of coronary hemodynamic and cardiac metabolic alterations during coronary artery spasm associated with ST segment elevation or depression.

1985 ◽  
Vol 49 (4) ◽  
pp. 422-431 ◽  
Author(s):  
KAZUHISA KODAMA ◽  
MASAKAZU YAMAGISHI ◽  
SHlNSUKE NANTO ◽  
TSUNEHIKO KUZUYA ◽  
YUKIHIRO KORETSUNE ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Spasm ◽  
Metabolic Alterations ◽  
St Segment Elevation ◽  
St Segment

scholarly journals The Challenges of Treating Acute Myocardial Infarction due to Variant Angina: Lesson from an Interesting Case

2020 ◽  
Author(s):  
Guo-Hua Li
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Artery Spasm ◽  
Interesting Case ◽  
Variant Angina ◽  
St Segment Elevation ◽  
St Segment

Coronary artery spasm can cause recurrent variant angina with ST-segment elevation. The patient was asymptomatic with normal vitals and ECG was normal. We present a case associated with transient ST-segment elevation and significant increase in troponin levels with non-critical lesion with normal CAG

Abstract 10989: Diagnostic Impact Of Electrocardiogram And Emergency Coronary Angiography In Patients With Out-of-hospital-cardiac-arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kazuya Tateishi ◽  
Daisuke Abe ◽  
Toru Iwama ◽  
Tatsuro Sassa ◽  
Kouichi Oohashi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Angina Pectoris ◽  
Coronary Angiography ◽  
Vasospastic Angina ◽  
St Segment Elevation ◽  
Coronary Lesion ◽  
St Segment ◽  
Number Of Patients ◽  
Vasospastic Angina Pectoris ◽  
Hospital Cardiac Arrest

Objective: The guideline suggests that coronary angiography (CAG) should be performed for the patients with out-of-hospital-cardiac-arrest (OHCA) and return of spontaneous cardiac arrest (ROSC). We investigated the association between initial ST-segment change after ROSC and incidence of acute coronary lesion in patients with OHCA. We also researched the number of patients with OHCA caused by vasospastic angina pectoris (VSA). Methods: From April 2011 to March 2015, there were 2,779 OHCA patients in our institution. We underwent CAG for all patients with ROSC, except for obvious extra-cardiac cause of OHCA. Initial ST-segment change after ROSC of serial 155 patients(61±14.5years old,83.9% male) was reviewed. Results: The 34% of patients had ST-segment elevation and the 66% had other electrocardiogram (ECG) pattern. Significant coronary lesion which needs percutaneous coronary intervention (PCI) was shown in the 81% of patients with ST-segment elevation and in 33% with other ECG (P<0.001). ST-segment analysis had a good positive predictive value (81%) but a low negative value (68%) in diagnosing the presence of acute coronary lesions. The patients who were diagnosed vasospastic angina were found in the 10% of patients with ST-segment elevation and in the 12% with other ECG. Conclusion: Even in the absence of ST-segment elevation, acute culprit coronary lesion may be present, and there is significant value to perform emergency CAG for ROSC patients. Furthermore, vasospastic angina pectoris may be present and considered the trigger of cardiac arrest. Emergency CAG could remove the coronary artery spasm by directly NO injection.

ST-segment elevation myocardial infarction

2015 ◽  
Author(s):  
Adrian Cheong ◽  
Gabriel Steg ◽  
Stefan K James
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Myocardial Necrosis ◽  
Coronary Intervention ◽  
Pump Failure ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Clinical Trial Evidence ◽  
Pain Symptoms

Acute myocardial infarction with ST-segment elevation is a common and dramatic manifestation of coronary artery disease. It is caused by the rupture of an atherosclerotic plaque in a coronary artery, leading to its total thrombotic occlusion and resultant ischaemia and necrosis of downstream myocardium. The diagnosis of ST-segment elevation myocardial infarction is based on a syndrome of ischaemic chest pain symptoms, associated with typical ST-segment elevation on the electrocardiogram and an eventual rise in biomarkers of myocardial necrosis. The treatment of ST-segment elevation myocardial infarction is focused on re-establishing blood flow in the coronary artery involved, preferably by percutaneous coronary intervention, or by pharmacological thrombolysis in the case of expected lengthy time delays or lack of availability of facilities. Early mortality from ST-segment elevation myocardial infarction can be attributed to the sequelae or complications of myocardial ischaemia, or complications related to therapy. The former include arrhythmias (such as ventricular tachycardia or fibrillation), mechanical complications (such as ventricular free wall, septal, and mitral chordal rupture), and pump failure leading to cardiogenic shock. The latter includes haemorrhagic complications and coronary stent thrombosis. Given that myocardial necrosis is a critically time-dependent process, the organization of an ST-segment elevation myocardial infarction care system and adherence to the latest clinical trial evidence and guidelines are crucial to ensure that patients are treated in an optimal manner.

scholarly journals A Case of Spontaneous Multivessel Coronary Artery Spasm That Underwent Stent Implantation Accompanying ST Segment Elevation on Inferior Electrocardiographic Leads

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Nuray Kahraman Ay ◽  
Muharrem Nasifov ◽  
Ömer Goktekin
Keyword(s):  
Blood Flow ◽  
Coronary Artery ◽  
Myocardial Ischaemia ◽  
Coronary Artery Spasm ◽  
Coronary Spasm ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Artery Segment ◽  
Artery Segment ◽  
Electrocardiographic Leads

Coronary artery spasm is usually defined as a focal constriction of a coronary artery segment, which is reversible, and causes myocardial ischaemia by restricting coronary blood flow. A coronary spasm may rarely compromise all three epicardial arteries simultaneously. We present a case of severe coronary spasm afflicting all coronary arteries accompanying an ST segment elevation in leads D2-D3 and aVF.

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