Slowcoronary flow is an attractive phenomenon, has been investigated for years.
Clinical features of slow coronary flow changes from just angina pectoris to
sudden cardiac death. It was first described by Tambe et al, in 1972. In this
case, we reported 41 years-old patient with no history of chronic disease, was
asked to perform treadmill test due to his family’s high cardiovascular risk
factors. Sudden cardiac death secondary to ventricular arrhythmia was also
reported before. In our case there was interestingly just cardiac asystole
without ventricular arrhythmia.
A51 years-old man was admitted to outpatient clinic for cardiac screening. When
medical anamnesis was deepened, we learned that he applied to cardiology clinic
because of high family cardiovascular risk factor. There was no exertional
chest pain and no history of medical drug usage in his anamnesis. Resting
Electrocardiogram (ECG) was totally normal. He underwent treadmill test on
Bruce protocol in order to induce coronary ischemia. In second minutes of the
treadmill test new left bundle branch block also extreme bradycardia appeared.
Sudden cardiac arrest occured Figure 1 After five minutes of cardiac
resuscitation heart rhythm was provided. 3 mg of atropine was intravenously
given to patients in five minutes in order to prevent the bradycardia.
Thepatient was immediately taken to the catheter laboratory. Coronary Angiography
(CAG) was performed, Left Anterior Descending artery (LAD) and Left Circumflex
Artery (LCX) were totally normal whereas there was extremely slow blood flow in
the Right Coronary Artery (RCA). CAG showed slow dye opasification and delayed
distal vessel clearance during selective injection in right coronary artery. To
standardize the degree of slow antegrade filling, TIMI frame count method was
used. Antegrade filling in the LAD and LCX was normal with TIMI 3 flow. In
contrast the patient had TIMI 2 flow in RCA, TIMI frame count was found to be
60.
No comments:
Post a Comment