NORMAL CORONARY ANGIOGRAM;

Objectives: To observe the clinical characteristics of patients having normalcoronary angiogram following an abnormal stress test or presented with chest pain indicatingcoronary angiogram. Study Design: A single center retrospective, descriptive study. Period:Coronary angiograms done from September 2015 to September 2016 were retrievedand reviewed for normal coronary arteries. Setting: Khatum-un-Nabyeen Heart Center.Methodology: Clinical profile of the patients having normal coronary angiogram was retrievedfrom hospital record. Results: Out of 900 angiograms reviewed, 81(9%) were having normalcoronary arteries. Mean age was 43±10 years. Females were 64.1%. Clinical characteristicof study group was as follows: smokers 32.09%, family history of premature coronary arterydisease 51.8%, hyperlipidemia 60.4% and hypertension 19.7%. Diabetes was present onlyin 20.9%. Among females: 19.2% were current users of oral contraceptives pills and 13.4%were post menopausal. Mean BMI was 25.4±4. Conclusion: Normal coronary angiogram isinfrequent observation in cardiac catheterization laboratories and mostly found in youngerto middle aged females. Family history of coronary artery disease and hyperlideimaare verycommon in such patients.

Takotsubo Cardiomyopathy in a Patient with Undiscovered Sigmoid Colon Cancer

Takotsubo cardiomyopathy (TTC) is a stress-related cardiomyopathy that is characterized by reversible left systolic dysfunction, which appears to be precipitated by sudden emotional or physical stress in the absence of myocardial infarction. Here we present a rare case that clinically presented with intermittent abdominal pain, initially impressed as non-ST elevation myocardial infarction and congestive heart failure but with a normal coronary angiogram. Her symptoms relieved spontaneously without returning. Sigmoid colon cancer was diagnosed via colonoscopy later due to persistent abdominal discomfort. In the absence of detectable emotional or physical stress factors, the newly diagnosed sigmoid colon cancer was the only possible trigger factor of TTC. We offer this case as a reminder that cancer should be considered in the differential diagnosis of patients presenting with the etiology of TTC.

Type 1 Kounis Syndrome in Patient with Idiopathic Anaphylaxis

Kounis syndrome represents the concurrence of acute coronary syndromes or anginal pain with allergic, hypersensitivity, and anaphylactic reactions. It can be associated with normal coronary angiogram or preexistent coronary pathology. Idiopathic anaphylaxis is defined as anaphylaxis without any identifiable precipitating agent or event. We present a case of male who experienced attacks of dyspnoea, hypoxemia, hypotension, purple-red skin, and chest pain over several years. He was diagnosed with idiopathic anaphylaxis. Based on the pattern of chest pain of ischemic origin during the attacks he was retrospectively diagnosed with Kounis syndrome.