ST-Segment elevation acute myocardial infarction due to severe hypotension and proximal left subclavian artery stenosis in a prior coronary artery bypass graft patient

Review of coronary subclavian steal syndrome

“…This phenomenon is known as coronarysubclavian steal syndrome (CSSS) (Fig. 1) and its consequences include angina, acute coronary syndrome, new-onset and decompensated heart failure, and malignant ventricular arrhythmias [14][15][16][17][18][19][20]. These serious and potentially catastrophic implications behoove screening for subclavian artery stenosis (SAS) prior to CABG and continued active surveillance for the interval development of SAS post CABG [21,22].…”

Síndrome Coronariana Aguda Como Apresentação Atípica Do Fenômeno De Roubo Subclávio

“…Vale ressaltar que a diferença de pressão arterial entre os membros superiores, assim como outros sinais clínicos, apresentaram baixa acurácia para predizer estenose angiográfica 9 . Atualmente, alguns centros realizam rotineiramente a avaliação da artéria subclávia esquerda proximal de todos pacientes submetidos a cineangiocoronariografia, independentemente do plano cirúrgico 6,10,11 . Outras modalidades diagnósticas são a ultrassonografia com Doppler antes e após exercício com membro superior, angiotomografia de tórax e ressonância magnética com angiografia.…”

“…Apresentamos acima um caso de SCA sem supradesnível do segmento ST ocasionada pela redução do fluxo coronariano secundária ao roubo coronariano associado ao estresse cirúrgico, principalmente devido ao sangramento transoperatório. Dimas et al 10 reportaram caso semelhante em paciente que desenvolveu SCA com supradesnível de segmento ST após hipotensão secundária a desidratação. Existem ainda outros casos relatados com elevação do segmento ST, porém com sintomatologia presente anos após a realização do procedimento 14,15 .…”

Sign of decreased coronary blood flow from ST depression and PVCs during a left lower lobectomy of the lung in a patient with a left internal mammary arterial bypass graft

“…A patent LIMA pedicle injury can cause a myocardial infarction [3]. One case was reported in which a myocardial infarction due to systemic hypotension and proximal left subclavian artery stenosis occurred in a patient with a previous LIMA to a LAD graft [4]. This case shows that myocardial infarction can be induced by decreased coronary blood flow due to direct injury of the LIMA pedicle or decreased flow of the artery that supplies the LIMA in a patent LIMA to a LAD graft in patients undergoing a left upper or lower lobectomy [3,4].…”

“…One case was reported in which a myocardial infarction due to systemic hypotension and proximal left subclavian artery stenosis occurred in a patient with a previous LIMA to a LAD graft [4]. This case shows that myocardial infarction can be induced by decreased coronary blood flow due to direct injury of the LIMA pedicle or decreased flow of the artery that supplies the LIMA in a patent LIMA to a LAD graft in patients undergoing a left upper or lower lobectomy [3,4]. In this case, the LIMA pedicle could not be directly visualized due to the severe adhesion, but ST-segment depression and the series of PVCs resulting after compression strongly indicated that the blood vessels responsible for coronary flow were directly affected.…”