PROLONGED SPASM OF THE LEFT ANTERIOR DESCENDING CORONARY ARTERY (case report)

1. PROLONGED SPASM OF THE LEFT ANTERIOR DESCENDING CORONARY ARTERY(case report) Kulić M., Mujičić E., Šošević A., Gorani D.*, Tahirović E., Spužić M. Heart center, KCU Sarajevo Cardiology Clinic, KC Priština* 5th Congress of Cardiologists and Angiologists of Bosnia and Herzegovina Sarajevo, 27-29 May, 2010,.Hotel Radon Plaza

2. SPASM OF THE CORONARY ARTERY • Definition • Pathophysiology • Frequency • Treatment • Case report • Conclusion Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

3. DEFINITION • In 1959, Prinzmetal et al described a syndrome of chest pain at restassociated with ST-segment elevation Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

4. PATHOPHYSIOLOGY • Coronary spasm is caused primarily by vascular smooth muscle cell hypercontraction Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

5. PATHOPHYSIOLOGY • Abnormalities of NO production • Activated platelets - releases thromboxane A2 • Low levels of intracellular magnesium and vitamin E as well. • Hyperinsulinemia and insulin resistance are probable risk factors for variant angina Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

6. FREQUENCY • 2-3% of all patients undergoing diagnostic cardiac catheterization in the USA • In Italy, the incidence of variant angina is approximately 10%. • A Japanese type of variant angina (termed vasospastic angina) with 20-30% of patients who undergo coronary angiography. Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

7. DIAGNOSIS • A 12-lead electrocardiograph should be repeated with each episode of chest pain • Serial cardiac enzyme assays • Holter monitoring • Exercise tolerance test • Thallium scintigraphy • Coronary angiography Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

8. MEDICAL THERAPY • Nitrates • Calcium channel blockers (CCBs) • Statins Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

9. CASE REPORT • 39-year old female patient • chest pain since february 2007. • EKG- SR, fr.: 75/min., neg T in D3, aVF, V1-V3 • RR: 120/80mmHg., P: 75/min • Lab exam: without abnormalities Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

11. SADA PRIKAZATI EKG 2007/2008 Kulić M, Mujičić E, Gorani D et al. Prolonged spasm of the LAD

12. EKG 2009.

13. Exercise tolerance testwas characteristically normal • slika ergometrije

14. CASE REPORT • Echocardiography was also normal with EF: 72%, without valvular abnormalities • She was planed for MSCT or for coronary angiography Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

15. CASE REPORT • Patient desided to performe directly coronary angiogram without MSCT • Patient came from Montenegro in our cath.lab • She also demanded coronary angiography by radial approach Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

16. Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

17. Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

18. Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

19. Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

25. Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

26. Conclusion • Spasm of coronary arteries is sometimes a life-threatening condition • The complete team, consisting of interventional cardiologist, intensivist/anesthesiologist and others, is necessery to be preasent for positive outcome of tretment of these patients. Kulić M, Mujičić E, Šošević A et al. Prolonged spasm of the LAD

27. Thank you