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[Two cases of acute coronary occlusion after successful coronary angioplasty associated with a treadmill stress
1Third Department of Internal Medicine, Toho University, School of Medicine.
Insights
Acute coronary occlusion can occur after successful percutaneous transluminal coronary angioplasty (PTCA) and treadmill stress testing. These cases highlight the importance of monitoring patients post-PTCA for potential cardiac events during exercise.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for treating coronary artery disease.
- Treadmill stress testing is used to evaluate for exercise-induced ischemia.
Observation:
- Two cases are presented where patients experienced acute coronary occlusion following successful PTCA and subsequent treadmill stress testing.
- Case 1 involved a 54-year-old man with effort angina who developed acute RCA occlusion post-PTCA during stress testing.
- Case 2 described a 68-year-old man with myocardial infarction who had LAD occlusion after PTCA and stress testing.
Findings:
- Both patients developed severe chest pain and ECG changes indicative of acute myocardial infarction shortly after exercise.
- Emergency repeat PTCA was required to restore blood flow in the occluded coronary arteries.
- These events occurred despite initially successful angioplasty and symptom-limited stress testing.
Implications:
- The findings suggest a potential risk of acute coronary occlusion during or after treadmill stress testing in patients who have undergone recent PTCA.
- Close monitoring and prompt recognition of ischemic symptoms post-PTCA are crucial.
- Further investigation may be warranted to understand the mechanisms and optimize management strategies for preventing such complications.
Abstract:
We presented two cases of acute coronary occlusion after successful percutaneous transluminal coronary angioplasty (PTCA) associated with a treadmill stress testing. Case 1: A 54-year-old man with effort angina was referred to our hospital for cardiac catheterization. At the time of cardiac catheterization, the proximal RCA had a 99% diameter narrowing, and the proximal LCX had a 90% diameter narrowing. PTCA was performed and both lesions were successfully dilated. Eight days after PTCA, he had a symptom-limited treadmill stress testing, using the Bruce protocol. The exercise was terminated at a peak heart rate of 173/min (103% of aged-predicted maximal heart rate), and at a maximal systolic blood pressure of 140 mmHg. A few minutes after the end of exercise, he developed a severe chest pain and ECG changes, which showed ST elevation in leads II, III, aVF and ST depression in leads V4-V6. Emergency coronary angiography disclosed an acute coronary occlusion of RCA at the site of PTCA. Emergency PTCA was performed and the lesion was successfully re-dilated. Case 2: A 68-year-old man was referred to our hospital for cardiac catheterization a month after subendocardial anterior myocardial infarction. At the time of cardiac catheterization, the proximal LAD have a 99% diameter narrowing. PTCA was performed and the lesion was successfully dilated. 18 days after PTCA, he had a symptom-limited treadmill stress testing, using the Bruce protocol. The exercise was terminated at a peak heart rate of 158/min (102% of aged-predicted maximal heart rate), and at a maximal systolic blood pressure of 218 mmHg. Ten minutes after the one of 218 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)