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Coronary artery spasm in heart transplant recipients
Insights
Coronary artery spasm is a rare complication in heart transplant recipients. Early detection and aggressive treatment with calcium antagonists are crucial for managing this condition and preventing adverse outcomes.
Area of Science:
- Cardiology
- Transplant Surgery
- Cardiovascular Research
Background:
- Coronary artery spasm is uncommon in transplanted, denervated hearts.
- Orthotopic heart transplantation involves complex surgical procedures and post-operative care.
Observation:
- Two cases of coronary artery spasm were documented in heart transplant recipients via coronary angiography.
- Electrocardiogram (ECG) and Holter monitoring revealed ischemic changes in both patients.
Findings:
- Both patients responded well to calcium antagonist therapy, with no recurrence of spasm.
- One patient experienced sudden death after discontinuing calcium antagonists, highlighting the importance of adherence.
Implications:
- Coronary artery spasm may be underdiagnosed in heart transplant patients.
- Routine 24-hour ECG monitoring is recommended for early detection.
- Aggressive management of coronary artery spasm is vital for improving outcomes in heart transplant recipients.
Abstract:
Coronary artery spasm has rarely been observed in the transplanted, denervated heart. We report two patients who had coronary artery spasm after orthotopic heart transplantation that was documented by coronary angiography while ECG and Holter monitoring showed ischemic changes. Both patients were treated with calcium antagonists with no further evidence of this complication; however, one patient died suddenly at home after calcium antagonists were arbitrarily withdrawn. We believe that coronary artery spasm in heart transplant recipients may occur more frequently than expected. Careful monitoring of 24-hour ECG should be considered routinely in the follow-up of such patients, and when coronary spasm occurs it should be aggressively treated.