Massive coronary subclavian steal syndrome
Yolanda Carrascal1, Jaime Arroyo, Juan José Fuertes
1Cardiac Surgery Department, Instituto de Ciencias del Corazón, Valladolid, Spain. ycarrascal@hotmail.com
The Annals of Thoracic Surgery
|August 25, 2010
Summary
Coronary subclavian steal syndrome, a rare cause of angina, occurs when blood flow reverses in internal mammary artery grafts. This case highlights its impact on cardiopulmonary bypass weaning in a patient with extensive vascular disease.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiology
Background:
- Coronary subclavian steal syndrome (CSSS) is an uncommon complication affecting patients with patent internal mammary artery (IMA) grafts.
- It results from reversed or diminished blood flow within the IMA graft, often due to subclavian artery stenosis.
Observation:
- A 60-year-old male patient with a history of cerebrovascular and peripheral artery disease presented with significant CSSS.
- The patient had undergone multiple coronary artery bypass grafting (CABG) procedures, including a double T-mammary artery graft.
Findings:
- The documented massive CSSS critically impaired the patient's ability to be weaned from cardiopulmonary bypass post-operatively.
- This underscores the potential severity of CSSS, even in patients with complex vascular histories.
Implications:
- Effective management of CSSS is crucial for successful post-operative recovery in complex cardiac surgical patients.
- Recognition of CSSS is vital for surgeons managing patients with IMA grafts and peripheral vascular disease.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
01:26Acute Coronary Syndrome V: Nursing Management
Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
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...
01:30Acute Coronary Syndrome III: Diagnostic Studies
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...
01:28Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
01:30Coronary Artery Disease III: Clinical Manifestations
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...