Coronary Slow Flow Phenomenon and Risk for Sudden Cardiac Death Due to Ventricular Arrhythmias: A Case Report and Review of Literature

Abstract

We report a case of coronary slow flow phenomenon (CSFP) in a patient who underwent coronary angiography due to anginal chest pain, and recurrent syncope with complete normalization of flow after intracoronary adenosine. The patient was noted to have multiple episodes of nonsustained ventricular tachycardia (VT) on holter monitor and increased QTc dispersion on surface electrocardiogram (ECG). He responded very well to oral dipyridamole therapy with complete resolution of his symptoms and no episodes of VT on the event recorder at 3 mo. We reviewed the diagnosis and clinical features of CSFP and its association with increased QTc dispersion, and the role of oral dipyridamole therapy in this condition.

Evaluation of Tp-Te Interval and Tp-Te/QT Ratio in Patients with Coronary Slow Flow Tp-Te/QT Ratio and Coronary Slow Flow

“…Increased cardiovascular morbidity and mortality have been demonstrated in patients with CSF in previous studies [8].…”

“…Impaired myocardial blood flow in CSF may cause fatal cardiac arrhythmias by bringing about electrical abnormalities during ventricular repolarization [8].…”

The Relationship between Ventricular Repolarization Indexes and Neutrophil to Lymphocyte Ratio in Patients with Slow Coronary Flow

“…Cardiac functions are negatively affected in SCF patients with reports of chest pain [1], evidence of subclinical atherosclerosis [2], left ventricular diastolic function abnormalities [7], conduction disturbances [9], increased frequency of ventricular arrhythmia (10), and cardiac autonomic dysfunction [11]. In addition, increased cardiovascular morbidity and mortality have been demonstrated in patients with SCF when compared to the controls [11,22].…”

“…Thus, the frequency of cardiovascular complications is increased in SCF patients. This includes impairment of left ventricular systolic and diastolic function [8], acute coronary syndromes [9], and sudden cardiac death due to malignant ventricular arrhythmias [10].…”

Transient Cardiac Ballooning—The Syndrome

“…49 This gives credence to the microcirculatory postischemic stunning hypothesis at least as a probable concurring phenomenon. A potential therapeutic study protocol based on the above platform could be the use of dipyridamole during LHC to increase adenosine diphosphate and vasodilate the microcirculation, 50 once the epicardial coronary angiogram is found to be nonobstructive, while still in the acute phase of the syndrome.…”