Recent years have witnessed progress in our understanding of coronary vasospasm(CVS).It is evident that this is not only an East Asian but also a global disease associated with significant symptoms and possible lethal...Recent years have witnessed progress in our understanding of coronary vasospasm(CVS).It is evident that this is not only an East Asian but also a global disease associated with significant symptoms and possible lethal sequelae for afflicted individuals.A correct diagnosis depends on the understanding of pathogenesis and symptomatology of CVS.With the correct diagnosis,we can manage CVS patients effectively and promptly,providing optimal patient safety.Advances in our understanding of interactions between inflammation,endothelium,and smooth muscle cells have led to substantial progress in understanding the pathogenesis of symptoms in CVS and have provided some insights into the basic etiology of this disorder in some patient subpopulations.We look forward to a time when therapy will address pathophysiology and perhaps,even the primary etiology.展开更多
Coronary vasospasm is a rare diagnosis resulting in sudden arrhythmic cardiac arrest. We report a case of a healthy,non-smoking elderly woman resuscitated from arrhythmic cardiac arrest. She had persistent spontaneous...Coronary vasospasm is a rare diagnosis resulting in sudden arrhythmic cardiac arrest. We report a case of a healthy,non-smoking elderly woman resuscitated from arrhythmic cardiac arrest. She had persistent spontaneous coronaxy vasospasm, leading to right ventricular myocardial injury and failure, and shock. She responded quickly to intravenous normal saline bolus infusion, but had irreversible neurological sequelae. Additionally, she had atrial fibrillation preceding ischemic ventricular fibrillation, a rare finding in coronary vasospasm-related cardiac arrest. We suggest immediate coronary angiography of patients in sudden arrhythmic cardiac arrest with acute right ventricular failure for a prompt,accurate diagnosis and appropriate management of the coronary vasospasm.展开更多
Kounis syndrome is defined as a group of acute coronary syndromes that manifests as unstable vasospasticor nonvasospastc angina, and even as acute myocarda! infarction triggered by the release of inflammatory mediator...Kounis syndrome is defined as a group of acute coronary syndromes that manifests as unstable vasospasticor nonvasospastc angina, and even as acute myocarda! infarction triggered by the release of inflammatory mediators following an allergic insult.1 Kounis syndrome is a rare and complex syndrome. Instant treatment decisions need to be made once it happens. Here, we defined a case of severe Kounis syndrome, culminating in acute coronary syndrome, as a result of an acute allergic reaction, which was likely related to iodinated contrast media or dextran-40 use. A 71-year-old male patient, with a history of hypertension, no history of coronary heart disease and diabetes, was admitted to our hospital because of intermittent claudication for one year. On admission, his temperature was 36.4℃, pulse was 80 beats/min, respiratory rate was 18 beats/rain and blood pressure was 105/80 mmHg （1 mmHg=0.133 kPa）. Physical examination did not show any sign of heart disease, but the lower extremity arterial pulsation was weak. His artery angiography of abdominal aorta and lower limbs showed that the left iliac artery was completely obstructed. A total of 400 U iodinated contrast media was used during the operation. The patient was back to ward safely. Ten minutes after taking the dextran-40 as a postoperative treatment, he began to present sudden hyperspasmia, transient unconsciousness, skin flushes, excessive sweating and sinus tachycardia （approximately 140 beats/min）. At the same time, his skin temperature decreased and his blood pressure collapsed quickly. He accepted oxygen therapy, fluid replacement, dexamethasone and dopamine immediately. After that the ECG revealed ST elevation of 0.3-0.7 mV in leads II, III, avF, V3.6, and frequent premature ventricular （Figure 1A）. Following the therapy of promethazine, glycerin trinitrate and lidocaine, the shock symptoms was gradually relieved： consciousness was recovered, ST segment gradually went back to normal in half an hour （Figure 1 B） and blood pressure incre展开更多
文摘Recent years have witnessed progress in our understanding of coronary vasospasm(CVS).It is evident that this is not only an East Asian but also a global disease associated with significant symptoms and possible lethal sequelae for afflicted individuals.A correct diagnosis depends on the understanding of pathogenesis and symptomatology of CVS.With the correct diagnosis,we can manage CVS patients effectively and promptly,providing optimal patient safety.Advances in our understanding of interactions between inflammation,endothelium,and smooth muscle cells have led to substantial progress in understanding the pathogenesis of symptoms in CVS and have provided some insights into the basic etiology of this disorder in some patient subpopulations.We look forward to a time when therapy will address pathophysiology and perhaps,even the primary etiology.
文摘Coronary vasospasm is a rare diagnosis resulting in sudden arrhythmic cardiac arrest. We report a case of a healthy,non-smoking elderly woman resuscitated from arrhythmic cardiac arrest. She had persistent spontaneous coronaxy vasospasm, leading to right ventricular myocardial injury and failure, and shock. She responded quickly to intravenous normal saline bolus infusion, but had irreversible neurological sequelae. Additionally, she had atrial fibrillation preceding ischemic ventricular fibrillation, a rare finding in coronary vasospasm-related cardiac arrest. We suggest immediate coronary angiography of patients in sudden arrhythmic cardiac arrest with acute right ventricular failure for a prompt,accurate diagnosis and appropriate management of the coronary vasospasm.
文摘Kounis syndrome is defined as a group of acute coronary syndromes that manifests as unstable vasospasticor nonvasospastc angina, and even as acute myocarda! infarction triggered by the release of inflammatory mediators following an allergic insult.1 Kounis syndrome is a rare and complex syndrome. Instant treatment decisions need to be made once it happens. Here, we defined a case of severe Kounis syndrome, culminating in acute coronary syndrome, as a result of an acute allergic reaction, which was likely related to iodinated contrast media or dextran-40 use. A 71-year-old male patient, with a history of hypertension, no history of coronary heart disease and diabetes, was admitted to our hospital because of intermittent claudication for one year. On admission, his temperature was 36.4℃, pulse was 80 beats/min, respiratory rate was 18 beats/rain and blood pressure was 105/80 mmHg （1 mmHg=0.133 kPa）. Physical examination did not show any sign of heart disease, but the lower extremity arterial pulsation was weak. His artery angiography of abdominal aorta and lower limbs showed that the left iliac artery was completely obstructed. A total of 400 U iodinated contrast media was used during the operation. The patient was back to ward safely. Ten minutes after taking the dextran-40 as a postoperative treatment, he began to present sudden hyperspasmia, transient unconsciousness, skin flushes, excessive sweating and sinus tachycardia （approximately 140 beats/min）. At the same time, his skin temperature decreased and his blood pressure collapsed quickly. He accepted oxygen therapy, fluid replacement, dexamethasone and dopamine immediately. After that the ECG revealed ST elevation of 0.3-0.7 mV in leads II, III, avF, V3.6, and frequent premature ventricular （Figure 1A）. Following the therapy of promethazine, glycerin trinitrate and lidocaine, the shock symptoms was gradually relieved： consciousness was recovered, ST segment gradually went back to normal in half an hour （Figure 1 B） and blood pressure incre
