Assuntos
Angina Pectoris Variante/diagnóstico por imagem , Angina Pectoris Variante/cirurgia , Angiografia Coronária , Morte Súbita Cardíaca/prevenção & controle , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/cirurgia , Desfibriladores Implantáveis , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Variant angina also called Prinzmetals angina is an enigma characterized by transient circadian symptoms of chest pain associated with ECG changes. The patient is symptom free with normal ECG and echo during symptom free periods. We present a case associated with transient ST-segment elevation with non critical lesion with normal FFR.
Assuntos
Angina Pectoris Variante/diagnóstico por imagem , Angina Pectoris Variante/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Stents , Angina Pectoris Variante/cirurgia , Eletrocardiografia/métodos , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Angina Pectoris Variante/diagnóstico , Angina Pectoris Variante/cirurgia , Trombose Coronária/diagnóstico , Trombose Coronária/cirurgia , Tomografia de Coerência Óptica , Idoso de 80 Anos ou mais , Angina Pectoris Variante/complicações , Trombose Coronária/complicações , Seguimentos , Humanos , Masculino , Stents , Resultado do TratamentoAssuntos
Angina Pectoris Variante/etiologia , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/patologia , Angina Pectoris Variante/cirurgia , Aterosclerose/complicações , Aterosclerose/patologia , Procedimentos Cirúrgicos Cardíacos , Angiografia Coronária , Anomalias dos Vasos Coronários/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Vasospastic angina usually responds well to medical treatment. HYPOTHESIS: The present study describes our experience in patients who received a coronary stent because of recurrent variant angina refractory to medical treatment and evaluates stent implantation as an alternative treatment. MATERIALS AND METHODS: Between March 1998 and February 2005, recurrent variant angina was diagnosed in 22 patients admitted to our coronary care unit. Of these, five patients (22.7%), were refractory to pharmacologic treatment. Coronary angiography and coronary stents were indicated. Clinical follow-up was 29 +/- 6 months. RESULTS: Stenting was performed during diagnostic coronary angiography in two patients. In the other three patients, the stent was implanted 24-48 h later. We observed coronary spasm recurrences proximal or distal to the stent in four patients-two during the stent implantation procedure and the other two in the coronary care unit within 48 h post angioplasty. Three patients where treated with additional stenting and the fourth patient improved with pharmacologic treatment. During follow-up three patients remained asymptomatic. The fourth patient had diffuse in-stent restenosis in the third month, and the fifth patient showed a de novo lesion in the treated segment 2 years later. CONCLUSIONS: Stent implantation in patients with recurrent variant angina refractory to medical treatment may be an alternative treatment in carefully selected, clinically unstable patients. Spasm recurrences may occur in other segments of the treated artery, probably due to the diffuse nature of the disease. Immediate and continued surveillance is recommended because of the risk of adverse clinical events.
Assuntos
Angina Pectoris Variante/tratamento farmacológico , Angina Pectoris Variante/cirurgia , Angioplastia Coronária com Balão , Vasoespasmo Coronário/cirurgia , Vasos Coronários/cirurgia , Stents , Idoso , Angiografia Coronária , Vasoespasmo Coronário/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Falha de TratamentoRESUMO
No disponible
Assuntos
Idoso , Humanos , Bloqueio Cardíaco/induzido quimicamente , Vasodilatadores/efeitos adversos , Vasodilatadores/uso terapêutico , Angina Pectoris Variante/induzido quimicamente , Angina Pectoris Variante/diagnóstico , Fascículo Atrioventricular , Angina Pectoris Variante/cirurgia , Fibrilação Atrial/tratamento farmacológico , Eletrocardiografia , StentsAssuntos
Aneurisma/diagnóstico por imagem , Ponte de Artéria Coronária , Oclusão de Enxerto Vascular/diagnóstico por imagem , Complicações Pós-Operatórias , Veia Safena , Idoso , Aneurisma/etiologia , Angina Pectoris Variante/cirurgia , Ponte de Artéria Coronária/métodos , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Veia Safena/transplante , Tomografia Computadorizada por Raios XRESUMO
We report about a 46 year old male, who survived sudden cardiac death caused by recurrent ventricular tachycardia as the clinical manifestation of a vasospastic right coronary artery. After implantation of an implantable cardioverter defibrillator, the patient did not respond to conservative treatment despite of different drug therapies. Therefore, the vasospastic right coronary artery was treated by a percutaneous transluminal coronary angioplasty and stenting, which could not reduce the occurrence of further tachycardias. Finally, the patient underwent an operative myocardial revascularization combined with sympathectomy. During the whole follow-up of six months no new episodes of ventricular tachyarrhythmias have occurred.
Assuntos
Angina Pectoris Variante/cirurgia , Revascularização Miocárdica , Simpatectomia , Taquicardia Ventricular/cirurgia , Angina Pectoris Variante/diagnóstico , Angina Pectoris Variante/fisiopatologia , Angioplastia Coronária com Balão , Desfibriladores Implantáveis , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevenção Secundária , Stents , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Falha de TratamentoRESUMO
CASE REPORT: A 41-year-old male saw his general practitioner because of progressive atypical angina symptoms and palpitations for the last 7 years. Chest X-ray showed a mediastinal mass. Further investigation by computed tomography (CT), magnetic resonance imaging (MRI) and cardiac catheterization revealed two bronchogenic cysts. After median sternotomy and pericardial incision, two cystic masses were found on top of and dorsal to the right atrium. Following resection, the patient was free of previously experienced problems related to his atypical angina symptoms. Histological investigation showed no signs of malignancy. CONCLUSION: In patients with atypical angina pectoris the rare case of a bronchogenic cyst has to be considered a possible reason for the symptoms. In addition, patients might show atrium-induced dysrhythmia, coughing with purulent sputum, and pain. CT and MRI are absolutely necessary for exclusion of metastases and aneurysms in the mediastinum.
Assuntos
Angina Pectoris Variante/etiologia , Cisto Broncogênico/diagnóstico , Cardiopatias/diagnóstico , Cisto Mediastínico/diagnóstico , Adulto , Angina Pectoris Variante/cirurgia , Cisto Broncogênico/cirurgia , Diagnóstico Diferencial , Átrios do Coração/cirurgia , Cardiopatias/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Cisto Mediastínico/cirurgiaRESUMO
The successful stent placement for treatment of recurrent vasospastic angina in a patient with nonstenotic coronary arteries is described. Use of the Palmaz-Schatz stent resulted in successful vasodilation that completely prevented anginal attacks. This procedure represents an alternative treatment for patients with vasospastic angina refractory to aggressive medical therapy.
Assuntos
Angina Pectoris Variante/cirurgia , Stents , Angina Pectoris Variante/diagnóstico por imagem , Angina Pectoris Variante/tratamento farmacológico , Angiografia Coronária , Quimioterapia Combinada , Tolerância a Medicamentos , Fibrinolíticos/administração & dosagem , Fibrinolíticos/uso terapêutico , Seguimentos , Heparina/administração & dosagem , Heparina/uso terapêutico , Humanos , Infusões Intravenosas , Dinitrato de Isossorbida/administração & dosagem , Dinitrato de Isossorbida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Recidiva , Terapia Trombolítica , Vasodilatadores/administração & dosagem , Vasodilatadores/uso terapêuticoRESUMO
Between June 1979 and May 1994, I performed 148 unilateral or bilateral sympathectomies on 247 limbs in 110 patients using a percutaneous radiofrequency technique, usually on an outpatient surgery basis. Patient ages ranged from 10 to 81 years, with 45 male and 65 female patients. Four patients had unsuccessfully undergone prior open surgical sympathectomy. Patients suffered from hyperhidrosis, vascular occlusion, Raynaud's disease or other chronic vasculopathies, painful causalgia or reflex sympathetic dystrophy, or Prinzmetal's angina. The sympathectomy technique has evolved over this 15-year period and is currently in its third phase. Changes in the procedure were based on anatomic and clinical/radiographic correlations and careful patient follow-up. Current modifications have reduced the frequency of both early and late failures. The present technique (Phase III) relies on neuroleptanalgesia with superficial local anesthesia only and does not require general anesthesia, intubation, or lung collapse. Two 18-gauge radiofrequency TIC needle electrodes (Radionics, Burlington, MA) are used. A series of three lesions is rostrocaudally made at each of the ganglion sites selected in an attempt to destroy the entire fusiform ganglion. Lesion sites are targeted by C-arm fluoroscopy and electrical stimulation, which produces a threshold of sensory awareness of > 1.0 V. Lesion effectiveness is monitored by bilateral finger plethysmography and hand skin temperature measurement. With the Phase III technique, the sympathetic activity in 96% of operated limbs after 2 years and in 91% of operated limbs after 3 years continues to be completely or largely interrupted. By comparison, I achieved similar success in 83 and 72% operated limbs with the Phase I technique and in 77 and 71% with the Phase II technique. Symptomatic pneumothorax, in six patients, has been the only serious complication. When necessary, a subsequent operation can easily be performed and is effective.
Assuntos
Eletrocirurgia/instrumentação , Simpatectomia/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios , Angina Pectoris Variante/cirurgia , Arteriopatias Oclusivas/cirurgia , Causalgia/cirurgia , Criança , Feminino , Humanos , Hiperidrose/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Doença de Raynaud/cirurgia , Distrofia Simpática Reflexa/cirurgia , Resultado do TratamentoAssuntos
Vasoespasmo Coronário/cirurgia , Vasos Coronários/cirurgia , Angina Pectoris Variante/diagnóstico , Angina Pectoris Variante/etiologia , Angina Pectoris Variante/cirurgia , Angiografia Coronária , Vasoespasmo Coronário/complicações , Vasoespasmo Coronário/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Indução de RemissãoRESUMO
From June 1990 to March 1993, 9 patients undergoing coronary artery bypass grafting (CABG), 4.4% of all CABG cases at our hospital during this period, had significant perioperative coronary spasm. For 4 patients who underwent CABG before May 1992 (Group 1), preventive and suppressive procedures for the coronary spasm were the addition of diltiazem in the cardioplegic solution and the continuous intravenous infusion of nitroglycerin. Perioperative myocardial infarction (PMI) occurred in all 4 patients in Group 1, with the mean peak MB-CPK of 356 +/- 197 IU/l. One patient had delayed sternal closure because of his unstable hemodynamic status. Thereafter, we changed our protocol as follows: 1) Ergometrine loading (intracoronary infusion) test was performed in all candidates for CABG, aiming at finding out patients with a high risk. And for the high-risk patients, in addition to the measures done in Group 1, 2) intraaortic balloon pumping was performed through the perioperative period, and 3) a pig-tail catheter was dwelled in the Valsalva sinus, through which bolus doses of isosorbide dinitrate were injected frequently in this period. 4) Additionally nifedipine was periodically administered through the nasogastric tube. With these intensive preventive/suppressive measures, the perioperative spasm in 5 patients (Group 2) with variant angina were successfully managed, with no resultant PMI nor operative death (The occurrence of PMI was significantly less frequent in Group 2 than in Group 1, with the p value < 0.05). For patients with variant angina undergoing CABG, combined intensive preventive/suppressive measures for perioperative coronary spasm as listed above proved effective.
Assuntos
Angina Pectoris Variante/cirurgia , Ponte de Artéria Coronária , Vasoespasmo Coronário/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Humanos , Dinitrato de Isossorbida/uso terapêutico , Masculino , Pessoa de Meia-IdadeAssuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Idoso , Doença das Coronárias/cirurgia , Angina Pectoris/cirurgia , Isquemia Miocárdica/classificação , Angina Pectoris Variante , Reoperação/mortalidade , Infarto do Miocárdio/cirurgia , Revascularização Miocárdica/estatística & dados numéricos , Fatores de Risco , Endarterectomia das Carótidas/normas , Complicações Intraoperatórias/classificação , Complicações Pós-Operatórias/classificação , Seguimentos , Angina Pectoris/classificação , Doença Crônica , Isquemia Miocárdica/cirurgia , Isquemia Miocárdica/diagnóstico , Angina Pectoris Variante/diagnóstico , Angina Pectoris Variante/cirurgia , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/mortalidade , Reoperação/efeitos adversos , Reoperação/economia , Revascularização Miocárdica/métodos , Revascularização Miocárdica/mortalidadeRESUMO
A 53 year old patient was hospitalized because of retrosternal oppression which was unrelated to effort and recurred in the early morning hours. An esophageal diverticulum and a hiatal hernia were found. The patient had complaints in spite of medical therapy and an operation was performed because of his oesophageal disorders. After operation the patient had the same pain. A cardiologist was asked, who suggested Prinzmetal variant angina. During arteriography coronary artery disease was found. Coronary bypass surgery was indicated and performed, after that procedure the patient was and remained free of any complaints. This observation reaffirmed Prinzmetal original statement "The key to the diagnosis ... is the taking of a painstaking history".
Assuntos
Angina Pectoris Variante/diagnóstico , Doença das Coronárias/diagnóstico por imagem , Divertículo Esofágico/complicações , Hérnia Hiatal/complicações , Angina Pectoris Variante/etiologia , Angina Pectoris Variante/cirurgia , Angiografia Coronária , Ponte de Artéria Coronária , Doença das Coronárias/cirurgia , Divertículo Esofágico/cirurgia , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/terapia , Hérnia Hiatal/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The present study investigates the prognostic significance of silent myocardial ischemia in variant angina. Forty-eight-hour Holter monitoring and coronary angiography were performed in 54 patients with transient ST elevation and no history of myocardial infarction admitted to the coronary care unit for worsening of symptoms. Coronary artery spasm was documented in most of these patients. Over the subsequent month, 20 patients (group 1) had a major coronary event (2 died, 6 had nonfatal myocardial infarction and 12 had urgent coronary revascularization), and the remaining 34 patients (group 2) had a good clinical outcome. From 2,578 hours of recording, 547 ischemic episodes were identified of which only 9% were associated with angina. The mean daily number of ST elevation in group 1 was similar to that in group 2 (4.8 +/- 5.1 vs 4.1 +/- 4.6; p = not significant). Conversely, the mean daily duration of such ischemic episodes was consistently greater in group 1 than in 2 (79 +/- 36 vs 37 +/- 25 minutes; p less than 0.005). The occurrence of greater than or equal to 1 long-lasting (greater than or equal to 10 minutes) episode of ST elevation was observed in 18 of 20 patients in group 1 (sensitivity 90%), but only in 4 of 34 in group 2 (specificity 88%). Significant coronary atherosclerosis (greater than 50% stenoses) was found at angiography in 18 of 20 patients in group 1, and in 18 of 34 in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Angina Pectoris Variante/complicações , Doença das Coronárias/complicações , Infarto do Miocárdio/etiologia , Angina Pectoris Variante/cirurgia , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença das Coronárias/cirurgia , Vasoespasmo Coronário/complicações , Eletrocardiografia Ambulatorial , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica , Probabilidade , Prognóstico , Sensibilidade e Especificidade , Fatores de TempoRESUMO
A case of a male 66 years-old patient who presented with a clinical picture of Prinzmetal's variant angina early in the evolution of an acute myocardial infarction is reported. Transient elevation of ST-segment was documented on Holter monitoring in association with angina at rest as well as asymptomatic episodes of ST-segment changes. Significant two-vessels obstructive lesions (left anterior descending and circumflex arteries) was present. As variant angina had several recurrences in spite of medical therapy with nitrates and calcium antagonists, the patient was submitted to coronary by-pass surgery associated to plexectomy. A Thallium myocardial scintigraphy suggests that a peroperative infarction had occurred. The patient was asymptomatic at six months follow-up.
Assuntos
Angina Pectoris Variante/cirurgia , Idoso , Angina Pectoris Variante/tratamento farmacológico , Angina Pectoris Variante/fisiopatologia , Eletrocardiografia , Eletrocardiografia Ambulatorial , Humanos , Dinitrato de Isossorbida/uso terapêutico , MasculinoRESUMO
Seven patients with coexistent Wolff-Parkinson-White (WPW) syndrome and variant angina pectoris underwent surgical interruption of an accessory atrioventricular conduction pathway. In two of these patients, perioperative coronary artery spasm occurred. One patient had a perioperative myocardial infarction and the other patient treated successfully had no infarction. Nitroglycerin and nifedipine were administered during and following operation in the other 5 patients without perioperative coronary artery spasm. No adverse effect was observed in the intraoperative electrophysiological study. Combined therapy of intravenous nitroglycerin administration and sublingual nifedipine administration are useful in the perioperative management of patients with coexistent WPW syndrome and variant angina pectoris.