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2024 | 78 | 304-308

Article title

Acute coronary syndrome as the first symptom of vasospastic angina – case report of a 38-year-old man with myocardial infarction with non-obstructive coronary artery disease

Content

Title variants

PL
Ostry zespół wieńcowy jako pierwszy objaw dławicy naczynioskurczowej – opis przypadku 38-letniego mężczyzny z zawałem serca bez istotnych zwężeń w tętnicach wieńcowych

Languages of publication

Abstracts

PL
38-letni otyły mężczyzna chorujący na nadciśnienie tętnicze z dwudziestoletnim wywiadem nikotynizmu został przyjęty z powodu podejrzenia zawału serca z uniesieniem odcinka ST (ST elevation myocardial infarction – STEMI). W koronarografii nie wykryto istotnych zwężeń tętnic wieńcowych, co łącznie z objawami ostrego zespołu wieńcowego oraz zwiększonym stężeniem troponiny I pozwoliło na rozpoznanie zawału serca bez zwężeń w tętnicach wieńcowych (myocardial infarction with non-obstructive coronary artery – MINOCA) i implikowało przeprowadzenie dia-gnostyki różnicowej. Ze względu na obraz kliniczny przeprowadzono próbę prowokacyjną z acetylocholiną, która wskazała na naczynioskurczowe pochodzenie MINOCA. W celu zmniejszenia prawdopodobieństwa kolejnego epizodu zmieniono farmakoterapię i zalecono zmianę stylu życia.
EN
A 38-year-old obese man with hypertension and a twenty-year history of nicotinism was admitted for a suspec-ted ST-segment elevation myocardial infarction (STEMI). Coronary angiography did not reveal significant corona-ry artery stenosis, which, together with symptoms of acute coronary syndrome and increased troponin I levels, led to the diagnosis of myocardial infarction with non-obstructive coronary artery disease (MINOCA) and im-plied a differential diagnosis. Given the clinical picture, a provocative test with acetylcholine was performed, which indicated the vasoconstrictive origin of MINOCA. In order to reduce the likelihood of another episode, pharmacotherapy was changed and lifestyle changes were recommended.

Year

Issue

78

Pages

304-308

Physical description

Dates

published
2024

Contributors

  • Department of Cardiology, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
  • Department of Cardiology, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
  • Department of Cardiology, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
  • Centre of Postgraduate Medical Education, Warsaw, Poland
  • Department of Cardiology, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
  • Centre of Postgraduate Medical Education, Warsaw, Poland

References

  • Byrne R.A., Rossello X., Coughlan J.J., Barbato E., Berry C., Chieffo A. et al. 2023 ESC Guidelines for the management of acute coronary syn-dromes. Eur. Heart J. 2023; 44(38): 3720–3826, doi: 10.1093/eurheartj/ehad191.
  • Knuuti J., Wijns W., Saraste A., Capodanno D., Barbato E., Funck-Brentano C. et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur. Heart J. 2020; 41(3): 407–477, doi: 10.1093/eurheartj/ehz425.
  • Prinzmetal M., Kennamer R, Merliss R., Wada T., Bor N. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am. J. Med. 1959; 27: 375–388, doi: 10.1016/0002-9343(59)90003-8.
  • Lanza G.A., Careri G., Crea F. Mechanisms of coronary artery spasm. Circulation 2011; 124(16): 1774–1782, doi: 10.1161/CIRCULATIONAHA.111.037283.
  • Marrone A., Pavasini R., Scollo E., Gibiino F., Pompei G., Caglioni S. et al. Acetylcholine use in modern cardiac catheterization laboratories: A system-atic review. J. Clin. Med. 2022; 11(4): 1129, doi: 10.3390/jcm11041129.
  • Hokimoto S., Kaikita K., Yasuda S., Tsujita K., Ishihara M., Matoba T. et al. JCS/CVIT/JCC 2023 guideline focused update on diagnosis and treatment of vasospastic angina (coronary spastic angina) and coronary microvascular dysfunction. Circ. J. 2023; 87(6): 879–936, doi: 10.1253/circj.CJ-22-0779.
  • Montone R.A., Meucci M.C., De Vita A., Lanza G.A., Niccoli G. Coronary provocative tests in the catheterization laboratory: Pathophysiological bases, methodological considerations and clinical implications. Atheroscle-rosis 2021; 318: 14–21, doi: 10.1016/j.atherosclerosis.2020.12.008.
  • Shibata K., Wakabayashi K., Ikeda N., Ishinaga T., Kusakabe Y., Masaki A. et al. Clinical implications of atrial fibrillation provoked by acetylcholine. Circ. Arrhythm. Electrophysiol. 2024; 17(9): e013015, doi: 10.1161/CIRCEP.124.013015.
  • Rehan R., Weaver J., Yong A. Coronary vasospastic angina: A review of the pathogenesis, diagnosis, and management. Life 2022; 12(8): 1124, doi: 10.3390/life12081124.

Document Type

Publication order reference

Identifiers

Biblioteka Nauki
54867319

YADDA identifier

bwmeta1.element.ojs-doi-10_18794_aams_190767
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