285 KB18 KB192920262004Cesar, FranciKranjec, IgorPernat, Andrejštevilka:11letnik:73str. 829-832ISSN:1318-0347COBISSID_HOST:18850777URN:URN:NBN:SI:doc-6BITINXYslSlovensko zdravniško društvoZdravniški vestnikAgedAngina Pectoris, VariantAngina pektoris variantnaCoronary AngiographyCoronary VasospasmDiagnosisDiltiazemDrug TherapyElectrocardiographyElektrokardiografijaHeart BlockHipotenzijaHypotensionKoronarna angiografijaKoronarni vazospazemNitroglicerinNitroglycerinSrce, blokStarostnikiTreatment OutcomeZdravljenje, izidPodaljšan večžilni spazem koronarnih arterij s klinično sliko akutnega miokardnega infarkta, kompletnega AV bloka in sinkope| Prolonged multiple spasms of smooth coronary arteries presenting as acute miocardial infarction, complete AV block and syncope|Background. A variant form of angina pectoris (VAP) is caused by coroynary vessel spasm and occures in patients with and without varying degrees of obstructive coronary artery disease. Although the prognosis of VAP without significant organic stenosis is generally good, multivessel spasm is associated with a high risk of life-threatening abnormalities of rhythm and conduction. Patient and methods. We describe a patient who presented with prolonged chest pain, associated with hypotension, lost of consciousness, complete AV block and widespread ST segment elevations consistent with inferoanterior acute myocardial infarction. Urgent selective coronary angiography revealed spasms in right coronary artery and in left circumflex artery that were relieved by intracoronary injection of nitroglycerin. All coronary arteries were otherwise patient, without signs of atherosclerosis. The patient was treated with diltiazem and nitrates. She made a complete recovery and resumed her normal activities. Conclusions. Simultaneous multiplespasms of native coronary arteries represent a rare syndrome characterized by signifacantly higher incidence of potentially life-threatening arrhythmia. Less commonly, prolonged coronary spasm may mimicacute myocardial infarction. Modern management of acute coronary syndromes, including urgent coronarography, enables a prompt differentiation between prolonged coronary spasm and atherosclerotic coronary disease, warranting different treatment strategies. Medical treatment with nitrates andcalcium channel blockers in most cases prevents recurrence of vasospasms and arrhythmiasIzhodišča. Variantna oblika angine pektoris (VAP) je povzročena s spazmom koronarnih arterij in se pojavi pri bolnikih z različnimi stopnjami obstruktivne koronarne bolezni ali redkeje brez nje. Čeprav je napoved izida VAP brez pomembne organske zožitve v splošnem dobra, je večžilni spazem pri njej povezan z visokim tveganjem za nastanek življenje ogrožujočih motenj ritma in prevajanja. Bolnik in metode. Opisan je primer bolnice z dolgotrajno bolečino za prsnico, ki jo je spremljala hipotenzija, izguba zavesti ter elektrokardiografski znaki akutnega srčnomišičnega infarkta spodnje stene in atrio-ventrikularni (AV) blok III. stopnje. Urgentna koronarografija je pokazala spazem desne koronarne arterije in leve cirkumfleksne arterije, ki jepo intrakoronarni injekciji nitroglicerina izginil. Ob tem so prenehale tudibolečine in motnje atrio-ventrikularnega prevajanja. Vse koronarne arterije so bile sicer brez zožitev in znakov ateroskleroze. Ob zdravljenju z diltiazemom in nitrati se napadi angine pektoris niso več ponavljali. Zaključki. Hkratni večžilni spazem sicer zdravih koronarnih arterij je redek sindrom, ki ga pogosto spremljajo nevarne motnje srčnega ritma. Redko je spazem tako dolgotrajen, da daje klinično sliko akutnega srčnomišičnega infarkta. Moderna obravnava akutnih koronarnih sindromov z urgentno koronarografijo omogoči takojšnjo diferencialno diagnozo podaljšanih vazospazmov in aterosklerotične bolezni koronarnih arterij, ki zahtevata različen terapevtski pristop. Pri vazospastični angini medikamentno zdravljenje v veliki večini primerov odpravi ponovne napade bolečin in motenj srčnega ritmaTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo