1/14. Recurrent syncopal episodes of neurocardiogenic origin in a patient suffering from cardiac syndrome-X.We describe the case of a 44-year-old man, with a history of recurrent syncopal episodes and effort angina, the latter attributed to cardiac syndrome-X, who was admitted to our department because of a syncopal episode. During his hospitalization laboratory investigations including haematologic and blood chemical findings, head C/T scan, electroencephalogram, 48-hour Holter monitoring, electrophysiologic testing and echocardiographic study disclosed no abnormalities. On the contrary, a passive upright tilt testing was found to be positive, resulting, approximately, in a 10-seconds time interval of asystole accompanied by syncope. The association in the same patient of cardiac syndrome-X and neurocardiogenic syncope, although never described before, might be explained by a similar pathophysiological mechanism, which is a sympathovagal imbalance.- - - - - - - - - - ranking = 1keywords = angina (Clic here for more details about this article) |
2/14. role of the vascular endothelium in patients with angina pectoris or acute myocardial infarction with normal coronary arteries.chest pain with normal coronary angiograms is a relatively common syndrome. The mode of presentation of this syndrome includes patients with syndrome X and patients with an acute myocardial infarction and angiographically normal coronary arteries. Different mechanisms have been proposed to elucidate the exact cause and to explain the various clinical presentations in these patients. Abnormalities of pain perception and the presence of oesophageal dysmotility have all been reported in patients with syndrome X. In situ thrombosis or embolization with subsequent clot lysis and recanalization, coronary artery spasm, cocaine abuse, and viral myocarditis have been described as potential mechanisms responsible for an acute myocardial infarction in patients with angiographically normal coronary arteries. Recent data suggest that both microvascular and epicardial endothelial dysfunction may play an important role in the pathophysiological mechanism of the syndrome of stable angina or acute myocardial infarction with normal coronary arteries.- - - - - - - - - - ranking = 5keywords = angina (Clic here for more details about this article) |
3/14. Alteration of coronary flow velocity during spontaneous angina in a patient with microvascular angina.Phasic coronary flow velocity in the left and right coronary artery was recorded in a patient with microvascular angina. Coronary flow velocity during anginal attack was characterized by diminished systolic forward velocity, the appearance of systolic flow reversal, increase in diastolic flow velocity and its rapid deceleration. It was also accompanied with abnormal coronary flow reserve. These findings completely recovered at follow-up examination. A subgroup of patients with microvascular angina may show unique and reversible coronary flow abnormalities during chest pain.- - - - - - - - - - ranking = 11keywords = angina (Clic here for more details about this article) |
4/14. Case 1. Cardiovascular dysfunction syndrome.A 56-year-old woman is referred with angina. A number of sequential management strategies have been attempted with varying results. Upon examination of her case, it is clear that she has cardiovascular dysmetabolic syndrome and is thus at high risk for adverse cardiovascular events. Two opinions for further management are presented.- - - - - - - - - - ranking = 1keywords = angina (Clic here for more details about this article) |
5/14. Gastric angina secondary to acute thrombosis of celiac artery.We report a 48-year-old woman with foregut ischemia with splenic infarct due to isolated celiac artery obstruction. The patient presented with acute-onset pain in the epigastrium 10-15 min after every meal. Investigations revealed obstruction of the celiac artery by artheromatous plaque. This patient had an acute thrombosis, which responded to anticoagulation.- - - - - - - - - - ranking = 4keywords = angina (Clic here for more details about this article) |
6/14. Resolution of syndrome X after eradication of virulent CagA-positive helicobacter pylori.A 42-year-old man with chest pain was found to have ST depression in leads V1 through V4. The coronary arteries appeared normal on angiography. Positive results of ventricular pacing and acetylcholine test led to a diagnosis of syndrome X. Other studies revealed gastritis due to CagA-positive helicobacter pylori. Classic therapy for angina did not resolve chest pain, but eradication of H. pylori led to disappearance of symptoms and negative test results.- - - - - - - - - - ranking = 1keywords = angina (Clic here for more details about this article) |
7/14. microvascular angina in a patient with aortic stenosis.A 39-year-old woman had exercise-induced ST segment depression associated with chest pain. Cardiac evaluation revealed moderate aortic stenosis (AS), related to the bicuspid valves, with an aortic mean pressure gradient of 22 mmHg, a calculated aortic valve area of 1.3 cm2 and normal left ventricular (LV) peak systolic and end-diastolic pressures, but no LV hypertrophy, resulting in normal LV wall stress. Although the coronary arteries were angiographically normal, rapid atrial pacing and an intracoronary papaverine injection revealed a significantly decreased coronary flow reserve (CFR), which may have played an important role in the pathogenesis of angina pectoris in this patient. Though the CFR is usually decreased in patients with AS, as well as in microvascular angina, in this particular case, it appeared to have decreased as a consequence of microvascular dysfunction rather than of AS-related mechanisms.- - - - - - - - - - ranking = 6keywords = angina (Clic here for more details about this article) |
8/14. Treatment of medically uncontrolled coronary artery spasm in the normal coronary artery with coronary stenting.We present a 53-year-old male with recurrent episodes of vasospastic angina and serious complications of coronary artery spasm including ventricular fibrillation and myocardial infarction, who was treated with coronary stenting at the site of ergonovine-induced coronary vasospasm where the coronary artery appeared angiographically normal, i.e., without evidence of atherosclerotic lesion.- - - - - - - - - - ranking = 1keywords = angina (Clic here for more details about this article) |
9/14. Unappreciable myocardial bridge causing anterior myocardial infarction and postinfarction angina.We report a case of anterior myocardial infarction in a middle-aged man without risk factors for atherosclerosis in whom myocardial bridge was diagnosed several years later. An abnormal wall motion during acute myocardial infarction masked the characteristic angiographic findings of myocardial bridge and rendered it unappreciable during the initial angiographic study.- - - - - - - - - - ranking = 4keywords = angina (Clic here for more details about this article) |
10/14. microvascular angina, adverse outcome: a case report.We encountered a patient with microvascular angina (MVA) who was died suddenly, and observed ST-segment elevation during attack without epicardial coronary arterial vasoconstriction, suggesting the occurrence of microvascular spasm. Doppler guide wire (DGW) and N-13 ammonia positron emission tomography (PET) demonstrate severe impairment of the coronary microcirculation extending throughout the whole of the left ventricle. Conventional medical treatment was not effective in this case. We speculate that the prognosis of microvascular angina with severe coronary microcirculatory disturbance and accompanied by microvascular spasm might not always be good. Therefore, methods for treating such cases need to be established.- - - - - - - - - - ranking = 6keywords = angina (Clic here for more details about this article) |
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