1/14. A 42-year-old man with recurrent myocardial infarction and normal appearing coronary arteries.We report the occurrence of a coronary mural thrombus and recurrent myocardial infarction in a patient with normal-appearing epicardial coronary arteries and small-vessel coronary artery disease. The current case emphasizes the importance of permanent medical treatment with anti-platelet and vasodilators in patients with small-vessel coronary artery disease.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/14. pseudoxanthoma elasticum with dipyridamole-induced coronary artery spasm: a case report.In patients with pseudoxanthoma elasticum, severe organic coronary artery stenosis often occurs without coronary risk factors. However, this report presents the case of a 49-year-old woman with pseudoxanthoma elasticum who had coronary artery spasm with an angiographically normal coronary artery. In addition, coronary artery spasm was provoked with dipyridamole thallium-201 cardiac imaging.- - - - - - - - - - ranking = 1.125keywords = coronary (Clic here for more details about this article) |
3/14. 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 = 1.125keywords = coronary (Clic here for more details about this article) |
4/14. 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 = 1keywords = coronary (Clic here for more details about this article) |
5/14. 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 = 0.125keywords = coronary (Clic here for more details about this article) |
6/14. 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 = 0.375keywords = coronary (Clic here for more details about this article) |
7/14. 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 = 2keywords = coronary (Clic here for more details about this article) |
8/14. 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 = 0.375keywords = coronary (Clic here for more details about this article) |
9/14. Provocation of microvessel spasm by low-dose acetylcholine in patients with suspected coronary artery disease--two case reports.Endothelial dysfunction plays an important role in the pathogenesis of cardiac syndrome X, and intracoronary low-dose acetylcholine infusion is a widely used diagnostic modality for studying the coronary artery endothelial function. The authors herein report 2 cases of cardiac syndrome X with coronary artery endothelial dysfunction and microvessel spasm. The findings of non-invasive testing were positive for ischemia. Coronary angiograms appeared entirely normal in both cases. However, the intracoronary infusion of low-dose (1.5-15 microg/minute) acetylcholine demonstrated an impairment of the coronary blood flow response and consequently provoked an ST-segment elevation in an electrocardiogram. The coronary angiograms showed no spasm in the epicardial arteries. These patients are thus suggested to have cardiac syndrome X with microvessel spasms associated with coronary artery endothelial dysfunction.- - - - - - - - - - ranking = 1.375keywords = coronary (Clic here for more details about this article) |
10/14. Report of a patient with syndrome X due to excessive adenosine effect: myocardial migraine without myocardial ischemia.A 53-year-old female presented with disabling chest pain. The pain had most of the characteristics of ischemic pain; however, the results of the initial clinical investigation were consistent with the diagnosis of syndrome X. That is, her treadmill exercise test was positive but her coronary angiogram was normal. A dipyridamole-thallium test resulted in severe chest pain, marked ST abnormalities, but no evidence of any focal reduction in flow. A dipyridamole stress echocardiogram revealed that left ventricular function was entirely normal during the dipyridamole-induced pain and ST segment abnormalities, making ischemia an unlikely cause for either. To attempt to account for this paradox, the hypothesis was generated that both the pain and ST segment abnormalities were due to a primary abnormality of adenosine metabolism rather than secondary to ischemia. Accordingly, adenosine-MIBI scans were done with and without pretreatment with aminophylline. Infusion of adenosine virtually immediately resulted in crushing chest pain and profound ST abnormalities again without any evidence of focal abnormalities of MIBI estimated flow. By contrast, administration of adenosine after pretreatment with aminophylline failed to produce either chest pain or ST abnormalities. Moreover, long term therapy with aminophylline almost entirely relieved the symptoms which had been so distressing. This case indicates that there is a subset of patients with syndrome X--in which faults in adenosine metabolism result in excessive adenosine accumulation or effect and this results, in turn, in adenosine-induced ischemic-like chest pain and adenosine-induced ST abnormalities. There is, however, no actual ischemia of the myocardium. Given the known effects of adenosine on coronary flow, the problem in this subset of patients appears to be equivalent to an attack of myocardial migraine and blockers of adenosine action might be of help to other patients with a similar pathophysiology for their chest pain.- - - - - - - - - - ranking = 0.25keywords = coronary (Clic here for more details about this article) |
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