Podaljšan večžilni spazem koronarnih arterij s klinično sliko akutnega miokardnega infarkta, kompletnega AV bloka in sinkope
Prolonged multiple spasms of smooth coronary arteries presenting as acute miocardial infarction, complete AV block and syncope

slovenian

2004

volume 73, issue 11

Slovensko zdravniško društvo
(Obvezni izvod spletne publikacije)

Background. A variant form of angina pectoris (VAP) is caused by coroynary vessel spasm and occures in patients with and without varying degrees of obstructive coronary artery disease. Although the prognosis of VAP without significant organic stenosis is generally good, multivessel spasm is associated with a high risk of life-threatening abnormalities of rhythm and conduction. Patient and methods. We describe a patient who presented with prolonged chest pain, associated with hypotension, lost of consciousness, complete AV block and widespread ST segment elevations consistent with inferoanterior acute myocardial infarction. Urgent selective coronary angiography revealed spasms in right coronary artery and in left circumflex artery that were relieved by intracoronary injection of nitroglycerin. All coronary arteries were otherwise patient, without signs of atherosclerosis. The patient was treated with diltiazem and nitrates. She made a complete recovery and resumed her normal activities. Conclusions. Simultaneous multiplespasms of native coronary arteries represent a rare syndrome characterized by signifacantly higher incidence of potentially life-threatening arrhythmia. Less commonly, prolonged coronary spasm may mimicacute myocardial infarction. Modern management of acute coronary syndromes, including urgent coronarography, enables a prompt differentiation between prolonged coronary spasm and atherosclerotic coronary disease, warranting different treatment strategies. Medical treatment with nitrates andcalcium channel blockers in most cases prevents recurrence of vasospasms and arrhythmias.

15.05.2023