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Nonobstructive Coronary Heart Disease and Coronary Artery Vasospasm
Published in Mark C Houston, The Truth About Heart Disease, 2023
In patients with CA-VS, the lumen of the coronary artery has no visible or documented plaque by coronary angiography, but the artery may have intense constriction or vasospasm that obstructs blood flow and causes anginal chest pain, tightness, pressure, shortness of breath, and, sometimes, an MI. A coronary artery spasm is a temporary tightening (constriction) of the muscles in the wall of one of the coronary arteries which can decrease or completely block blood flow to sections of the heart (Figure 16.1).
Case 3.5
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
Let’s consider another scenario: You release a severe contracture, and the finger remains white after tourniquet release. How would you manage that?The causes of this are either:systemic vasoconstriction, ora digital artery injury, ordigital artery spasm.
The Coronary Arteries: Atherosclerosis and Ischaemic Heart Disease
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Coronary artery spasm is a controversial topic for pathologists as it is impossible to detect on histological analysis and it is diagnosed by exclusion of other causes for myocardial infarction. During life, it is known as vasospasmic angina, is more common in females and can lead to ACS, MI and cardiac arrhythmias. It is presumed to be the cause of SCD when there is transmural myocardial ischaemic damage (acute and/or chronic) in the wall of the ventricle (in the absence of any coronary artery pathology [see Table 2.3]). The ischaemic damage is regional pointing to a regional arterial transient blockage/spasm. Thrombotic/embolic disease with lysis is a possibility in these cases, but there is no source for thrombosis or emboli found at autopsy. Hypercoagulable syndromes may be an explanation. It is also linked to drug use, particularly cocaine.26
Coronary vasospasm as an etiology of recurrent ventricular fibrillation in the absence of coronary artery disease: a case report
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Binita Bhandari, Tejaswi Kanderi, Keerthi Yarlagadda, Mehreen Qureshi, Saketram Komanduri
Vasospastic angina can occur in patients with or without atherosclerotic vasculature. It can have focal or diffuse involvement of coronary arteries or epicardial microvasculature [3]. Multiple mechanisms have been proposed for the pathogenesis of coronary artery spasm including vascular smooth muscle hyperactivity, altered autonomic system, endothelial dysfunction, low–grade inflammation, electrolyte abnormalities, and oxidative stress. Vascular smooth muscle hyperactivity is considered a key factor [3]. The symptoms show diurnal variation, occurring more often at night. Increased fibrin formation and decreased fibrinolytic activity at night are considered to be the underlying mechanism [4]. Hyperinsulinemia, some genetic factors, and systemic vasomotor disorders like migraine or Raynaud’s phenomenon have also been associated with increased risk for this condition [5–7].
The high dose unfractionated heparin is related to less radial artery occlusion rates after diagnostic cardiac catheterisation: a single centre experience
Published in Acta Cardiologica, 2021
Feyzullah Besli, Fatih Gungoren, Zulkif Tanriverdi, Mustafa Begenç Tascanov, Halil Fedai, Huseyin Akcali, Recep Demirbag
Radial artery spasm was defined on the basis of the following five signs: i) persistent forearm pain, ii) pain response on catheter manipulation, iii) pain response to withdrawal catheter, iv) difficult catheter or introducer sheath manipulation after being “trapped” by the radial artery v) considerable resistance on withdrawal of the introducer sheet. Radial spasm was considered as the presence of at least 2 of these 5 signs. Also, RAS was divided into three groups based on severity; mild RAS group includes only mild pain in persistent forearm with catheter manipulation, moderate RAS includes severe pain response to catheter manipulation and/or withdrawal catheter or sheet, severe RAS includes severe pain with catheter or introducer sheath trapped by the radial artery as well as when the operator considered it necessary to administer a second dose of the spasmolytic or analgesics agent.
Coronary vasospasm complicating atrial fibrillation ablation: a case report and review of the literature
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Nirmal Guragai, Upamanyu Rampal, Rahul Vasudev, Pragya Bhandari, Atul Prakash, Hartaj Virk, Mahesh Bikkina, Shamoon Fayez
Ablative procedures have been developed as a curative approach for various arrhythmias including atrial fibrillation. Such procedures focus on the interruption of the electrical pathways that contribute to atrial fibrillation through modifying the arrhythmia triggers [1]. Percutaneous catheter-based radiofrequency ablation (RFA) is a widely used technique for atrial fibrillation where intracardiac mapping identifies a discrete arrhythmogenic focus that is the target of ablation. The ablation can be done, either endocardial or epicardial approach. Coronary artery spasm following ablation is rare and has been reported previously. Most of the case reports involve transient one vessel spasm with spontaneous resolution or requiring administration of IC nitroglycerin. However, ventricular fibrillation due to diffuse spasm of multiple coronary vessels after RFA is exceedingly rare. Upon our literature review (Table 1) we found only two cases (Fujiwara et al. and Kagawa et al.) that developed cardiac arrest [1–9]. Among all the reported cases of coronary artery spasm, only the case by Kagawa et al. had the involvement of multiple coronary vessels. Analyzing the published case reports, it was found that the most commonly involved artery was the right coronary artery. Usage of nitroglycerine either intravenous or intracoronary was noted to be the most common management for such spasms. ST-segment elevation in inferior leads was the most commonly noted ECG findings.