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Coronary artery slow flow associated with angina pectoris and hypotension--a case report
B A Burckhartt1, V Mukerji, M A Alpert
1Division of Cardiology, University of South Alabama, Mobile 36617, USA.
Insights
A patient experienced chest pressure and hypotension during a coronary angiogram, revealing slow blood flow in coronary arteries that resolved with nitroglycerin. This suggests a novel cause of myocardial ischemia.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Coronary angiography is a standard procedure for diagnosing coronary artery disease.
- Myocardial ischemia can result from various factors, including atherosclerosis and vasospasm.
Observation:
- A 56-year-old woman with angina developed chest pressure and hypotension during coronary angiography.
- Baseline coronary angiogram was normal.
- Contrast injection revealed slow flow in the left anterior descending and circumflex arteries.
Findings:
- Coronary artery slow flow was observed during contrast injection.
- The slow flow normalized after sublingual nitroglycerin administration.
- No evidence of focal coronary artery spasm was detected.
Implications:
- This case may represent a previously unrecognized mechanism of myocardial ischemia.
- Understanding this phenomenon could refine diagnostic and therapeutic strategies for ischemic heart disease.
- Further research is warranted to elucidate the underlying pathophysiology.
Abstract:
A 56-year-old woman with a history of angina pectoris developed substernal chest pressure and hypotension during coronary angiography. Her baseline coronary angiogram appeared normal. During this episode, injection of contrast medium into the left coronary artery demonstrated coronary artery slow flow in the left anterior descending artery and branches of the circumflex coronary artery, which normalized following the sublingual administration of nitroglycerin. There were no focal areas of coronary artery spasm. This phenomenon may represent a heretofore undescribed mechanism for myocardial ischemia and its sequelae.