A most unusual acute coronary syndrome.

The Canadian Journal of Cardiology
C BourgaultPaul Poirier

Abstract

A 60-year-old man, known for stable coronary artery disease, was admitted for suspected unstable angina. In the previous month, the patient presented with progressive dyspnea on light exertion. In the preceding four months, he had experience occasional episodes of flushing and diarrhea, and had inexplicably lost 22.7 kg. Night sweats and fever were absent. ST segment elevation in the inferior leads and ST segment depression in the precordial leads were documented during an episode of chest pain. The coronary angiogram showed diffuse disease with 70% stenosis of the left anterior descending coronary artery and 50% stenosis on the second diagonal (D(2)). An echocardiogram showed a patent foramen ovale. Balloon angioplasty and stenting were performed on the two lesions. Two days later, prolonged chest pain recurred. Cardiac catheterization was repeated and showed occlusive thrombus within the stent on the D(2). Angioplasty was repeated. Symptoms recurred 36 h later, with the electrocardiogram showing ST segment elevation. The first angiogram was reviewed and vasospasm was suspected on a branch of the D(2), on the second marginal and in the distal circumflex artery. The diagnosis of vasospastic angina was retained. Beta-blockers we...Continue Reading

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Citations

Sep 1, 2006·Photomedicine and Laser Surgery
Nov 10, 2012·Case Reports in Gastroenterology·Anton F EngelsmanAlex Katinakis
Dec 26, 2006·Der Internist·P Rellecke, B E Strauer
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Aug 15, 2017·Case Reports in Gastrointestinal Medicine·Jochen StenzelFlorian Eyer
Mar 6, 2019·Texas Heart Institute Journal·Pradhum RamGregg S Pressman

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