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[Occlusion of the left main coronary artery with silent ischemia and syncope]
A Sánchez González1, J A Fournier Andray, J A Pérez Fernández-Cortacero
1Unidad de Hemodinámica y Cardiología Intervencionista, Hospital General Universitario Virgen del Rocío, Sevilla.
Insights
Total left main coronary artery occlusion is often fatal. This case highlights a rare instance of this condition presenting solely with syncope, normal rest ECG, and silent ischemia, without typical angina or heart failure.
Area of Science:
- Cardiology
- Ischemic Heart Disease
Background:
- Left main coronary artery occlusion typically presents with severe symptoms and high mortality.
- Few survivors are usually critically ill and symptomatic.
Observation:
- A patient with total left main coronary artery occlusion presented with syncope as the sole symptom.
- The patient had a normal resting electrocardiogram and no history of angina.
Findings:
- Angiographic documentation confirmed total left main coronary artery occlusion.
- Severe isolated silent myocardial ischemia was induced during an exercise stress test.
- This represents the first reported case of left main coronary artery occlusion with silent ischemia and no cardiac failure.
Implications:
- Challenges the typical presentation and prognosis of left main coronary artery occlusion.
- Highlights the importance of considering silent ischemia in unexplained syncope.
- Suggests potential for novel diagnostic and management strategies in rare cardiovascular presentations.
Abstract:
Mortality in the total occlusion of the left main coronary artery is very high, and the few cases who lived reported were very ill and symptomatic patients. We present a case with angiographic documentation of total occlusion of the left main coronary artery in a patient without angina and with a normal rest electrocardiogram in which a syncope was the only symptom. Severe isolated silent ischemia was induced during an exercise test. Total occlusion of the left main coronary artery associated to silent myocardial ischemia without cardiac failure has never been previously reported.