Coronary artery vasospasm causing acute myocardial infarction in a heart transplant recipient

Early right coronary vasospasm presenting with malignant arrhythmias in a heart transplantation recipient without allograft vasculopathy

“…Bisognano et al [7] described a case of myocardial infarction in a patient symptomatic for chest pain, but with a history of severe vascular rejection, associated with diffuse vasospasm and evidence of mild stenosis in all coronary vessels.…”

“…This accurate evaluation demonstrates that coronary vasospasm after heart transplantation carries a poor prognosis and is often an early manifestation of organic coronary lesion. Impaired vasomotor function is historically considered not implicated in the pathogenesis of vasospasm of the graft in relation to cardiac denervation, but it has been recently documented that an intact autonomic nervous system and cardiac innervation is not essential for coronary vasospasm [7] and it is possible that circulating neurohumoral agents could induce endothelium damage and muscle vascular cells vasospasm.…”

Coronary allograft vasculopathy and coronary vasospasm in heart transplant recipients: A manifestation of Kounis syndrome?

“…Although their patient did show evidence of CAV during the episode of coronary vasospasm this event could be an early sign in the early stage of CAV. Severe or mild episodes of vascular rejection may precede or follow coronary vasospasm or acute myocardial infarction [2]. Coronary vasospasm alone or progressing to acute myocardial infarction is not common following heart transplantation.…”

“…This entity is the major cause of death following transplantation. CAV accounts for 40% of deaths greater than two years post cardiac transplant [2]. Diffuse and concentric neointimal proliferation leading in obliteration of the arteries is the main finding.…”

“…In this patient, diffuse lymphocytic infiltration suggesting hypersensitivity reaction linked to coronary vasospasm was found in postmortem coronary examination. Acute rejection affecting primarily the coronary arteries could represent a predisposing factor for coronary spasm, coronary thrombosis and acute myocardial infarction according to some reports [10] Other data suggest that coronary spasm is often associated with pre-existing atherosclerosis, reperfusion injury after transplantation, circulating neurohumoral agents which can induce endothelial damage and endothelial dysfunction with an abnormal response to acetylcholine [1][2][3][4][5][6][7][8][9][10][11][12]. The latter can predict subsequent cardiac death and CAV.…”