Normal angiogram in acute coronary syndromes: The underestimated role of alternative substrates of myocardial ischemia

Rigatelli, Gianluca; Rigatelli, Gianluca; Paolo, Rossi; Docali, Giorgio

doi:10.1007/s10554-004-1924-x

Cited by 21 publications

(16 citation statements)

References 26 publications

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“…Acute myocardial infarction(AMI) associated with DER in a young man with normal coronary arteries has been reported in the literature (11). The incidence of AMI in patients with normal or near normal coronary arteries ranges from 1% to 12% and mainly affects young people and is distinctly rare in patients older than 50 years (12). The mechanism leading to AMI in these patients remain unknown.…”

Section: Discussionmentioning

confidence: 99%

Disulfiram Ethanol Reaction with Ischemic Stroke

Babu¹,

Shetty²,

Aiyappa³

et al. 2014

Electron J Gen Med

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Section: Discussionmentioning

confidence: 99%

Disulfiram Ethanol Reaction with Ischemic Stroke

Babu¹,

Shetty²,

Aiyappa³

et al. 2014

Electron J Gen Med

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“…Paradoxical coronary embolism (PCE) accounts for 10-15% of all paradoxical emboli, and 25% of acute coronary events in patients less than 35 years of age: a patent foramen ovale (PFO) or an atrial septal defect (ASD) has been occasionally described as a source of paradoxical embolism [19][20][21][22]. On the basis of published case reports there are some characteristic features helping in the diagnosis of MI due to PCE.…”

Section: Streszczeniementioning

confidence: 99%

Coronary embolism causing acute myocardial infarction. Review of the literature

Zachura¹,

Piątek²,

Kurzawski³

et al. 2016

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Coronary artery embolism (CE) should be considered as a nonatherosclerotic cause of acute myocardial infarction (AMI), especially in patients with conditions favouring the formation of intracardiac thrombi. The main aetiologies of CE have changed in recent decades. Currently, atrial fibrillation is the most common cause. Most studies on CE infarcts are case reports with small numbers of patients. There are still no clear guidelines for the management in embolic myocardial infarction. Depending on the aetiology, the treatment needs to be tailored individually. As long-term outcomes indicate, patients with CE causing AMI are at high-risk and therefore require close follow-up. StreszczenieZator tętnicy wieńcowej należy podejrzewać w przypadku ostrego zespołu wieńcowego u pacjentów bez choroby miażdży-cowej, ale z czynnikami ryzyka sprzyjającymi powstawaniu skrzeplin wewnątrzsercowych. Najważniejsze etiologie zatoru tętnic wieńcowych zmieniały się w ciągu ostatnich dekad. Obecnie za najczęstszą przyczynę uznaje się migotanie przedsionków. Większość prac na temat zawałów spowodowanych zatorem tętnicy wieńcowej to opisy przypadków z niewielką liczbą przedstawionych pacjentów. Niestety nadal nie ma jasnych wytycznych co do diagnostyki oraz leczenia zatoru tętnic wieńcowych. W zależności od etiologii leczenie powinno być dopasowane indywidualnie. Jak wskazują wyniki długoter-minowych obserwacji, pacjenci z zawałem w wyniku zatoru tętnicy wieńcowej stanowią grupę wysokiego ryzyka, która wymaga dokładnej obserwacji.Approximately 5% of all patients with acute myocardial infarction (AMI) do not have atherosclerotic coronary artery disease [1]. Coronary artery embolism (CE) should be suspected in patients with factors or comorbidities predisposing to embolic events, who develop severe chest pain with elevated cardiac enzymes. Large diversity of aetiologies makes the precise diagnosis challenging. Most studies on coronary artery embolic infarcts are case reports with a small number of patients. There are still no clear guidelines for diagnostic criteria and the management of such cases. The approach of this paper is to provide a literature review of the CE causing AMI.Results from research by Prizel et al. revealed the incidence of coronary artery embolic infarcts in 55 out of 419 patients, which comprised 13% of autopsy-studied infarcts [2]. In another recent mechanistic study, based on analysis of 1776 patients with de novo AMI, the prevalence of CE was 2.9% [3]. The growing importance of invasive diagnostic and therapeutic methods provides a wealth of information about CE and its aetiology. There are a number of causes of coronary artery embolism. Analysis of the four main autopsy studies reported in the literature [4][5][6] with additional recently published mechanistic study [3], shows how the aetiology of CE has varied over the last half-century. Initially infective endocarditis accounted for more than half of all cases, then with the widespread use of antibiotics non-infected valvular heart disease became more ...

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“…Hence, it is interesting to note that among these 5 patients, calcium antagonists have suppressed or reduced chest pain, while beta blockers are ineffective. Although the relationship between coronary spasm, angina, and electrical changes in the ECG is certain in studies (16)(17)(18), the role of coronary spasm as a cause of myocardial necrosis has been widely discussed (19). Many reports imply that vasospasm may be the triggering factor leading to thrombosis of MI and normal coronary artery (5,20,21).…”

Section: Mechanism Of MImentioning

confidence: 99%

Myocardial Infarction and Normal Coronary Arteries: The Experience of the Cardiology Department of Sfax, Tunisia

et al. 2012

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Objective The purpose of the present study is to describe our experience with patients who have a transmural myocardial infarction (MI) in the presence of a normal coronary artery. The clinical profile, demographic characteristics and outcomes of these patients are discussed. Methods Between January 2006 and August 2011, 21 patients who presented with a Q-wave myocardial infarction were found to have normal coronary arteries. The prevalence rate of this entity was 1.5% (21 out of 1,400 Q wave MI patients). These patients were characterized by their young age (the mean age=44.95± 14.86), male dominance (90.47%), and a high prevalence of smoking (85.71%). In this study, 4 patients have an evident spontaneous spasm shown on coronary angiography which disappeared after intracoronary injection of nitrates. Coagulation Disorders, such as activated protein C resistance (APC) resistance, protein C deficiency and antiphospholipid antibody syndrome were found in 4 of 12 patients who underwent systematic examination. One patient had a history of lung cancer which may be associated with a hypercoagulable state and may explain the occurrence of myocardial infarction with a normal coronary artery. The mean left ventricle ejection was 56. 5±12. The mean follow-up was 24±10 months. Six patients developed residual chest pain which was generally easily controlled by anti-spastic therapy and no patient had a major cardiovascular event.Conclusion Patients with Q-wave MI and with normal coronary arteries seem to have a good short and long-term prognosis especially when they are treated with an exclusive medical strategy.

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Normal angiogram in acute coronary syndromes: The underestimated role of alternative substrates of myocardial ischemia

Cited by 21 publications

References 26 publications

Disulfiram Ethanol Reaction with Ischemic Stroke

Disulfiram Ethanol Reaction with Ischemic Stroke

Coronary embolism causing acute myocardial infarction. Review of the literature

Myocardial Infarction and Normal Coronary Arteries: The Experience of the Cardiology Department of Sfax, Tunisia

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