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Increased myocardial ischemia during nitrate therapy: caused by multiple coronary artery-left ventricle fistulae?

Gulumser Heper1, Sedat Kose

  • 1Department of Cardiology, SSK Ihtisas Hospital, Turkey. heperg@hotmail.com

Texas Heart Institute Journal
|May 21, 2005
PubMed

Insights

A 54-year-old man experienced worsening chest pain (crescendo angina) despite nitrate treatment. This unusual reaction may be due to a coronary steal phenomenon caused by abnormal blood vessel connections.

Area of Science:

  • Cardiology
  • Vascular Biology

Background:

  • Crescendo angina typically indicates unstable coronary artery disease.
  • Nitrate therapy is a standard treatment for angina pectoris.

Observation:

  • A 54-year-old male patient presented with crescendo angina refractory to nitrate therapy.
  • Coronary angiography revealed no atherosclerotic lesions.
  • Abnormal intramural vascular plexuses connecting coronary systems and the left ventricle were identified.

Findings:

  • The patient's condition suggests a non-atherosclerotic cause of myocardial ischemia.
  • The presence of intramural vascular plexuses may predispose to paradoxical reactions to vasodilators.

Implications:

  • This case highlights the coronary steal phenomenon as a potential cause of nitrate-induced angina.
  • Understanding these vascular anomalies is crucial for managing refractory angina.
  • Further research into intramural coronary vascular networks and their functional significance is warranted.

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