Myocardial ischemia in the setting of extrinsic coronary compression: two case reports
Himax Patel1, Amr Essa2, Musa Sharkawi2
1Department of Internal Medicine, Augusta University Medical Center, Augusta, GA, USA.
Insights
Extrinsic compression of coronary arteries is a rare cause of myocardial ischemia, leading to cardiac arrest. Prompt diagnosis and intervention, such as stenting, are crucial for managing this condition.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Myocardial ischemia results from reduced blood flow to the heart muscle.
- While atherosclerosis is the primary cause, extrinsic compression of coronary arteries is a rare but critical etiology.
- Causes include external pressure from dilated pulmonary arteries or mechanical obstruction from chest tubes.
Observation:
- Two cases of myocardial ischemia leading to cardiac arrest due to extrinsic coronary compression are presented.
- Case 1 involved postoperative chest tube compression of a venous bypass graft.
- Case 2 involved left main coronary artery compression by a dilated pulmonary artery secondary to pulmonary artery hypertension.
Findings:
- Diagnosis was established using emergent coronary angiography and intravascular ultrasound.
- Treatment involved drug-eluting stents for left main coronary artery compression and bypass graft stenting after chest tube adjustment.
- Both interventions successfully restored coronary blood flow.
Implications:
- Clinicians must recognize extrinsic coronary compression as a rare cause of myocardial ischemia.
- Awareness facilitates timely diagnosis and appropriate management, potentially preventing severe morbidity and mortality.
- This highlights the importance of considering non-atherosclerotic causes of coronary obstruction.
Background:
Myocardial ischemia occurs in the setting of inadequate or complete cessation of blood supply to the myocardium. While atherosclerosis is the most common cause; other causes have been identified. Rare cases can be caused by extrinsic compression of the coronaries by a dilated pulmonary artery (PA) or by mechanical obstruction from nearby chest tubes or drains. We present two cases of myocardial ischemia-driven malignant arrhythmia leading to cardiac arrest caused by obstruction of the coronary blood flow from external compression.
Case Description:
In the first case, venous bypass graft compression from a chest tube postoperatively was noted and in the second case left main coronary artery (LMCA) compression from a dilated PA secondary to pulmonary artery hypertension (PAH) was seen. Diagnosis of these two cases was made via emergent coronary angiogram and intravascular ultrasound (IVUS) and treated by placing a drug eluting stent (DES) in LMCA compression and by adjusting the chest tube and placing a DES in the venous bypass graft with the restoration of flow. We also review the available literature regarding the incidence, diagnosis, and management of this rare entity.
Conclusions:
Overall, extrinsic compression of the coronaries is rare, therefore clinicians need to be aware of this infrequent process, to allow for appropriate diagnosis, management, and to prevent excess morbidity and mortality from this rare complication.
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