| Autor: |
Wang, Andy, Meir, Juliet, Malik, Aaqib, Fishkin, Tzvi, Dey, Subo, Panza, Julio A, Haidry, Syed |
| Zdroj: |
Future Cardiology; 2024, Vol. 20 Issue 11/12, p613-618, 6p |
| Abstrakt: |
Coronary vasospasm can lead to decreased cardiac perfusion and result in acute coronary syndrome. Here is a case of a 49-year-old man presented to the emergency department with epigastric pain and nausea with normal initial electrocardiogram. However, 6 h later, the patient experienced severe chest pain prompting a repeat electrocardiogram demonstrating inferior ST-segment elevation with troponin I levels peaked at 1.2 ng/ml (normal range: 0.00–0.02 ng/ml). Coronary angiography revealed angiographic stenosis in the left circumflex territory of a left dominant system which resolved with intracoronary nitroglycerin administration indicating ischemia with nonobstructive coronary arteries secondary to coronary vasospasm. He was discharged on isosorbide mononitrate and amlodipine therapy and had no recurrence of symptoms during follow-up. Article highlights Coronary vasospasm can present as an acute coronary syndrome that is clinically indistinguishable from the more common pathophysiology of an atherosclerotic plaque rupture. Immediate coronary angiography is necessary to make the correct diagnosis and to deliver the appropriate therapy with intracoronary vasodilators, if necessary. Multiple mechanisms for coronary artery vasospasm have been implicated, including vascular smooth hyperreactivity from enhanced Rho-kinase enzyme activity, endothelial cell dysfunction and changes in autonomic nervous system activity. The mainstay of management for vasospastic angina primarily involves coronary vasodilators, namely calcium channel blockers as first-line therapy, long-acting nitrates, nicorandil and Rho-kinase inhibitors. Coronary vasospasm may be challenging to diagnose because of its transient nature, and should be suspected as a potential etiology in patients presenting with recurrent angina and otherwise nonobstructive coronary artery disease on coronary angiography. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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