Assessment of coronary morphology and flow in a patient with Guillain-Barré syndrome and ST-segment elevation

Area of Science:

• Cardiology
• Neurology

Background:

• Guillain-Barré syndrome (GBS) is frequently associated with autonomic dysfunction, leading to cardiac disturbances like arrhythmias and blood pressure abnormalities.
• Cardiac manifestations in GBS are typically related to autonomic dysregulation, affecting heart rate and blood pressure control.

Observation:

• A patient with GBS presented with ST-segment elevation, mimicking acute coronary syndrome.
• Cardiac catheterization revealed normal coronary arteries and normal intracoronary ultrasound findings.
• Electrocardiographic changes were not attributable to myopericarditis, as confirmed by echocardiography and endomyocardial biopsy.

Findings:

• Intracoronary Doppler flow measurements showed elevated baseline coronary flow velocity and reduced coronary flow reserve, particularly in the left circumflex artery.
• These findings suggest abnormal coronary hemodynamics in the absence of obstructive coronary artery disease.
• The observed abnormalities in coronary blood flow are hypothesized to stem from autonomic dysfunction.

Implications:

• Autonomic dysfunction in GBS can lead to significant cardiac electrical and hemodynamic abnormalities that mimic acute coronary syndromes.
• Understanding these mechanisms is crucial for accurate diagnosis and management of cardiac complications in GBS patients.
• This case highlights the importance of considering non-atherosclerotic causes of myocardial ischemia in the context of neurological disorders with autonomic involvement.