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The Application of Coronary Contrast Emptying Time in Diagnosing Coronary Slow Flow Phenomenon: A Serial Case Report
Yudhie Tanta1, Ali Ghanie, Taufik Indrajaya
1Division of Cardiovascular, Department of Internal Medicine, Faculty of Medicine Universitas Sriwijaya - Dr. Mohammad Hoesin Hospital, Palembang, Indonesia.. tanta7an7a@yahoo.com.
Insights
Coronary slow flow phenomenon, often overlooked, can cause acute coronary syndromes. Prolonged coronary contrast emptying time, not delayed filling, may be a more consistent indicator in these cases.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Coronary slow flow phenomenon (CSFP) is often underestimated, considered benign.
- However, CSFP can present as acute coronary syndrome, myocardial ischemia, arrhythmia, and sudden cardiac death.
Observation:
- CSFP diagnosis typically relies on delayed coronary contrast filling during angiography without significant epicardial narrowing.
- Clinical experience reveals cases of myocardial ischemia/infarction with normal angiography findings for filling time.
- These cases often show prolonged coronary contrast emptying time instead.
Findings:
- This case series suggests microvascular disorders in some CSFP patients.
- Delayed coronary contrast filling was not consistently observed in ischemic arteries.
- Prolonged coronary contrast emptying time emerged as a more reliable indicator.
Implications:
- Re-evaluation of diagnostic criteria for CSFP is warranted.
- Microvascular dysfunction may play a significant role in CSFP.
- Focusing on contrast emptying times could improve diagnosis and management of CSFP.
Abstract:
The Coronary Slow Flow Phenomenon doesn't achieve as much attention as its counterpart Coronary Arterial Disease because it is considered a rather benign entity. But now it is proven that coronary slow flow phenomenon can also manifest as an acute coronary syndrome, myocardial ischemia, malignant arrhythmia, and even sudden cardiac death.This entity is usually diagnosed from coronary angiography study when a delayed coronary contrast filling time is found without the presence of significant epicardial narrowing of the related arteries. But, in our center's years of experience, we frequently found cases in which myocardial ischemia or infarction was suggested or proven clinically, on the other hand, angiography study showed no significant epicardial coronary artery narrowing neither delayed coronary contrast filling time. Furthermore, we observed that this group of patients exhibited a rather prolonged coronary contrast emptying time instead.In this serial case report, we presented some of our cases where microvascular disorders were suspected. We demonstrated that not all coronary contrast filling times in ischemic or infarction-related arteries were prolonged, on the other hand, prolongation of coronary contrast emptying time showed a more consistent result.
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