Related Experiment Videos
[Coronary-subclavian steal syndrome]
A T Bäumer1, G Nickenig, D Moka
1Klinik III für Innere Medizin, Germany.
Deutsche Medizinische Wochenschrift (1946)
|June 27, 2002
Summary
Recurrent angina after coronary artery bypass grafting (CABG) may indicate coronary-subclavian steal syndrome. This condition, characterized by arm blood pressure differences, is best treated with subclavian artery revascularization.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common treatment for coronary triple vessel disease.
- Recurrent angina after CABG can have various causes, including graft failure or new stenoses.
Observation:
- A patient with generalized atherosclerosis experienced recurrent angina triggered by left arm exercise 17 months post-CABG.
- Stress technetium scans revealed left ventricular ischemia during left upper limb exercise.
- Coronary angiography showed reverse flow in the internal mammary artery (IMA) graft and left subclavian artery blockage.
Findings:
- The patient presented with a coronary-subclavian steal syndrome.
- A significant pressure difference (>20 mmHg) between arms is typical for this syndrome.
- Reverse flow in the IMA graft suggests steal phenomenon.
Implications:
- Coronary-subclavian steal syndrome should be considered in post-CABG patients with recurrent angina, especially when symptoms are arm-exercise induced.
- Percutaneous transluminal revascularization of the subclavian artery is the preferred treatment.
- Early diagnosis and intervention can prevent further cardiac events.