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Don't Ignore That Chest Pain: Positionally Dependent Coronary Subclavian Steal Syndrome

Michael Coles1, Chinmaya Mareddy, Vishal Arora

  • 1Department of Cardiology, Augusta University Medical Center, 1120 15th Street, Augusta, GA 30912 USA. michaeljohncoles@gmail.com.

The Journal of Invasive Cardiology
|February 3, 2021
PubMed

Insights

Coronary subclavian steal syndrome (CSSS) after bypass surgery can compromise heart blood flow. This case highlights a rare positional angina linked to arm movement, suggesting a dual cause.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Cardiac Surgery

Background:

  • Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
  • Coronary subclavian steal syndrome (CSSS) is a known complication of CABG, particularly when using the left internal mammary artery (LIMA) graft.
  • CSSS involves retrograde flow in the LIMA graft to the left subclavian artery (SCA) due to SCA stenosis, impairing myocardial perfusion.

Observation:

  • A 40-year-old female with a history of triple-vessel CABG presented with crescendo angina.
  • Angina symptoms were notably exacerbated by elevating her arms above her head.
  • This positional angina is atypical for CSSS, which is typically associated with claudication.

Findings:

  • The patient's presentation suggests a unique manifestation of CSSS.
  • Angiography is recommended for left SCA and LIMA graft evaluation in cases of atypical angina post-LIMA bypass.
  • The findings point towards a combined mechanism of demand ischemia and mechanical obstruction.

Implications:

  • This case expands the understanding of CSSS presentation and pathophysiology.
  • Positional angina related to arm activity warrants consideration of CSSS.
  • Further research into the dual pathophysiological mechanisms of CSSS is needed.

Keywords:
cardiac imagingpost-CABG complicationsubclavian steal syndrome

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