A 75-year-old woman with chest pain and transient severe left ventricular systolic dysfunction

Mâncio, Jennifer; Caeiro, Daniel; Faria, Rita; Marques, M; Bernardino, Sofia; Oliveira, Marco; Albuquerque, Aníbal; Ribeiro, Vasco Gama

doi:10.1016/j.repc.2015.03.017

Cited by 3 publications

(1 citation statement)

References 13 publications

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“…Intracoronary spasm provocation testing can be complicated by tachycardias (ventricular tachycardia, ventricular fibrillation) in 3.2% of cases or bradycardia (most often resulting from atrioventricular block) in 2.7% of cases according to a large Japanese multicenter registry comprised of 1,244 patients undergoing intracoronary spasm provocation testing . Reduced left ventricular function is an important relative contra‐indication for intracoronary spasm provocation testing, as illustrated by a case of a 75‐year‐old woman with areas of transmural and subendocardial infarction on MRI who died after uncontrollable vasospasm induced after intracoronary spasm provocation testing .…”

Section: Discussionmentioning

confidence: 99%

Recurrent myocardial infarction in a 47‐year‐old woman with a mechanical mitral valve prosthesis: Atherosclerosis, embolism, or spasm?

Claessen

Boogert

Piek

2017

Cathet Cardio Intervent

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We present a case of a 47-year-old woman with a mechanical mitral valve prosthesis and recurrent myocardial infarction. The most common etiology of spontaneous myocardial infarction is an acute coronary syndrome caused by rupture or erosion of an atherosclerotic plaque. However, the differential diagnosis in the patient described below also included infarction due to embolization or coronary spasm. It can be challenging to discriminate between the different causes of myocardial infarction based on interpretation of symptoms, physical examination, laboratory tests, and electrocardiography alone. This report illustrates the value of coronary angiography with invasive coronary spasm provocation testing using intracoronary acetylcholine to identify the etiology of her recurrent myocardial infarctions.

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Section: Discussionmentioning

confidence: 99%

Recurrent myocardial infarction in a 47‐year‐old woman with a mechanical mitral valve prosthesis: Atherosclerosis, embolism, or spasm?

Claessen

Boogert

Piek

2017

Cathet Cardio Intervent

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Acetylcholine

2015

Reactions Weekly

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S Acetylcholine Coronary spasms, AV block and heart arrest: case reportA 75-year-old woman developed atrioventricular (AV) block, coronary spasms, heart arrest and died after receiving intracoronary acetylcholine for a provocation test [time to reaction onset not stated].The woman had a complicated cardiac history including hypertension, recurrent chest pain, widespread ST-segment decompression, severe left ventricular systolic dysfunction, inferoseptal transmural infarct scar, inferolateral subendocardial infarct, mid-basal ischaemia of the anterolateral and anterior walls, and mechanical aortic prosthesis. She was admitted with chest pain and underwent a provocation test with intracoronary acetylcholine, which was administered into her left anterior descending artery (LAD; 20-100µg) in a stepwise manner and the right coronary artery (RCA; 20-50µg) over a period of 20 seconds in 3-5 minute intervals. Following acetylcholine injection into the LAD, she developed chest pain, ST-segment depression, transient grade 3 AV block and a LAD TIMI blood flow of 1.The woman received nitrates and her coronary spasm and AV conduction disturbances resolved. However, 20 minutes later, her ischaemic ST changes and chest pain returned. She received nitrate infusions with a poor response and she developed heart arrest with pulseless electrical activity. She received advanced life support for 32 minutes, but spontaneous circulation did not return. Mancio J, et al. A 75-year-old woman with chest pain and transient severe left ventricular systolic dysfunction. Revista Portuguesa de Cardiologia 34: 621 e1-e8, No. 10, Oct 2015. Available from: URL: http://doi.

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ST Segment Elevasyonu ve Total AV Blok’un Eşlik Ettiği Çoklu Damar Vasospastik Anjina

Taş¹,

Taş²,

Kaya³

2020

Sakarya Medical Journal

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A 49-year-old female patient was admitted to our hospital with ST segment elevation in the inferior derivations (D2, D3, aVF) and a total atrioventricular block. The initial electrocardiography performed on the patient in the coronary intensive care unit showed no total AV block and no ST segment elevation. The patient was accepted as a transient ST segment elevation MI and a coronary angiogram was performed. The coronary angiogram showed critical lesions in the left main coronary artery (LMCA) and the right coronary artery (RCA). We thought that the patient's condition might have been caused by vasospasm and gave intracoronary nitroglycerin. Subsequently, we noticed that the vasospasm disappeared and formed TIMI-3 flow again. The patient's chest pain disappeared. The patient's diagnosis was determined to be vasospastic angina, and she was given treatment accordingly. The patient was discharged, and the chest pain did not recur at 1 year follow up.

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A 75-year-old woman with chest pain and transient severe left ventricular systolic dysfunction

Abstract: Provocation tests have a high sensitivity and specificity for the diagnosis of vasospastic angina. Although it is rare, these tests have the potential risk of irreversible spasm leading to arrhythmia and death.

Cited by 3 publications

References 13 publications

Recurrent myocardial infarction in a 47‐year‐old woman with a mechanical mitral valve prosthesis: Atherosclerosis, embolism, or spasm?

Recurrent myocardial infarction in a 47‐year‐old woman with a mechanical mitral valve prosthesis: Atherosclerosis, embolism, or spasm?

Acetylcholine

ST Segment Elevasyonu ve Total AV Blok’un Eşlik Ettiği Çoklu Damar Vasospastik Anjina

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