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Angina II: Classification

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Angina, also known as angina pectoris, is a chest pain resulting from diminished blood flow to the heart muscle and is often a symptom of coronary artery disease. Angina presents several variants with distinctive attributes, etiologies, and therapeutic approaches. The main types of angina include stable, unstable, variant (Prinzmetal's), microvascular, intractable, and silent ischemia.Stable angina is caused by atherosclerosis, which leads to the formation of plaques that narrow the coronary...
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Coronary Artery Disease (CAD) is a primary health risk worldwide, leading to significant morbidity and mortality. The condition arises from the buildup of atherosclerotic plaques within the coronary arteries, resulting in diminished blood supply to the heart muscle.The clinical manifestations of CAD vary widely, from asymptomatic stages to severe, life-threatening conditions. Understanding these manifestations is crucial for early diagnosis and effective management.Angina Pectoris: The Warning...
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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
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An electrocardiogram (ECG or EKG) is a critical diagnostic tool that records the electrical signals produced by the heart during each heartbeat. This recording is achieved through electrodes placed strategically on the arms, legs, and chest. The electrocardiograph amplifies these signals and produces 12 distinct tracings, offering a comprehensive understanding of the heart's electrical activity.
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Recurrent ST-segment elevations in a patient without significant coronary disease.

Ryoji Iida1, Seiji Yazaki, Shigeru Saeki

  • 1Department of Anesthesiology, Surugadai Nihon University Hospital, Tokyo 101-8309, Japan. ryoiida@beach.ocn.ne.jp

Journal of Clinical Anesthesia
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Summary

This case study details recurrent ST-segment elevations, indicative of coronary artery spasm, occurring seven times during surgery and post-surgery in a patient without prior heart disease. These episodes highlight the potential for cyclic coronary artery spasm in the perioperative period.

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Area of Science:

  • Cardiology
  • Anesthesiology
  • Gastrointestinal Surgery

Background:

  • Perioperative myocardial ischemia can manifest atypically.
  • Coronary artery spasm is a potential cause of myocardial ischemia.
  • Understanding triggers and patterns of perioperative coronary artery spasm is crucial.

Observation:

  • A patient undergoing subtotal gastrectomy experienced recurrent ST-segment elevations seven times within three hours.
  • Episodes occurred during the surgical procedure and early postoperative phase.
  • No prior history of coronary artery disease was noted.

Findings:

  • Initial episodes required advanced cardiac life support, including epinephrine and defibrillation for ventricular fibrillation.
  • Subsequent episodes were managed with intravenous nitrates.
  • Postoperative coronary angiography confirmed coronary artery spasm.

Implications:

  • This case demonstrates that coronary artery spasm can occur repeatedly and cyclically during the perioperative period.
  • Factors such as cold stimulus, epidural anesthesia, and anesthetic depth may contribute to perioperative coronary artery spasm.
  • Clinicians should consider coronary artery spasm in patients presenting with unexplained ST-segment elevations during or after surgery.