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Pre-infarction angina secondary to calcific aortic stenosis with Bernheim's effect
Insights
Severe aortic stenosis can cause pre-infarction angina without coronary artery disease. Intra-aortic balloon pump counterpulsation stabilized the patient, allowing safe procedures and revealing right heart pressure abnormalities that resolved after aortic valve surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Physiology
Background:
- Pre-infarction angina typically suggests coronary artery disease.
- Severe calcific aortic stenosis is a significant cardiovascular condition.
- Right heart pressure abnormalities can impact cardiac function.
Observation:
- A 62-year-old male presented with pre-infarction angina despite the absence of coronary artery disease.
- Intraaortic balloon pump (IABP) counter-pulsation was used for stabilization, enabling safe coronary arteriograms.
- Cardiac catheterization revealed elevated right atrial and right ventricular end-diastolic pressures, consistent with Bernheim's effect.
Findings:
- The patient's pre-infarction angina was attributed to severe calcific aortic stenosis.
- IABP counter-pulsation provided hemodynamic stability in this unusual presentation.
- Surgical correction of aortic stenosis normalized the previously observed right heart hemodynamics.
Implications:
- This case highlights a rare cause of angina secondary to severe aortic stenosis.
- Intra-aortic balloon pump counter-pulsation can be a crucial stabilizing tool in complex cardiac scenarios.
- Understanding the right heart pressure dynamics is essential for managing aortic stenosis complications.
Abstract:
Pre-infarction angina, in the absence of coronary artery disease, was found in a 62 year-old man with severe calcific aortic stenosis. After application of intraaortic balloon pump counter-pulsation, the condition was stabilized, and coronary arteriograms were safely carried out. Interestingly, an elevated right atrial and right ventricular end-diastolic pressure with an associated Bernheim's effect was demonstrated by cardiac catheterization. The hemodynamics of the right heart returned to normal after surgical correction of the aortic stenosis. The clinical indications for intra-aortic balloon pump counterpulsation in this setting are discussed.