Coronary subclavian steal syndrome causing myocardial Infarction.
Paurush Ambesh1, Khalid Sawalha2, Kevin Groudan2
1Department of Cardiovascular Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA.
Annals of Cardiac Anaesthesia
|April 22, 2021
Summary
Coronary subclavian steal syndrome (CSSS) is a rare complication after coronary artery bypass surgery. This case highlights myocardial infarction caused by subclavian artery stenosis, emphasizing the need for vigilant diagnosis.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary subclavian steal syndrome (CSSS) is a rare complication following coronary artery bypass grafting (CABG) using the internal mammary artery (IMA).
- CSSS involves reduced blood flow or flow reversal in the IMA graft, leading to myocardial ischemia.
- It is typically caused by hemodynamically significant proximal subclavian artery stenosis.
Observation:
- Clinical presentation of CSSS is highly variable, ranging from unstable angina to myocardial infarction and sudden cardiac arrest.
- Diagnosis can be challenging, and the condition's prevalence is often underestimated.
- This case report details a myocardial infarction precipitated by significant proximal subclavian artery stenosis.
Findings:
- The case illustrates a direct link between proximal subclavian artery stenosis and myocardial infarction in a patient with a history of IMA grafting.
- The findings underscore the importance of considering CSSS in patients presenting with ischemic symptoms post-CABG, especially with risk factors for subclavian stenosis.
Implications:
- Increased awareness and diagnostic vigilance for CSSS are crucial among clinicians managing patients post-CABG.
- Early identification and management of subclavian artery stenosis can prevent severe ischemic events like myocardial infarction.
- This case contributes to the understanding of CSSS pathophysiology and clinical recognition.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
242
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...
242
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
110
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...
110
01:30Acute Coronary Syndrome III: Diagnostic Studies
68
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...
68
01:26Acute Coronary Syndrome V: Nursing Management
109
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,...
109
01:28Acute Coronary Syndrome IV: Interprofessional Care
74
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...
74
01:30Coronary Artery Disease III: Clinical Manifestations
120
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...
120