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.

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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

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MEDICAL THERAPY

• Nitrates

• Calcium channel blockers (CCBs)

• Statins

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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

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SADA PRIKAZATI EKG 2007/2008

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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

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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