Vojnosanitetski pregled 2011 Volume 68, Issue 7, Pages: 611-615
https://doi.org/10.2298/VSP1107611P
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Vasospastic angina pectoris complicated by acute myocardial infarction and complete atrioventricular block
Pavlović Milan (Klinički centar Niš, Klinika za kardiovaskularne bolesti, Niš)
Koraćević Goran (Klinički centar Niš, Klinika za kardiovaskularne bolesti, Niš)
Ćirić-Zdravković Snežana (Klinički centar Niš, Klinika za kardiovaskularne bolesti, Niš)
Krstić Nebojša (Klinički centar Niš, Klinika za kardiovaskularne bolesti, Niš)
Stojković Aleksandar (Klinički centar Niš, Klinika za kardiovaskularne bolesti, Niš)
Damjanović Miodrag (Klinički centar Niš, Klinika za kardiovaskularne bolesti, Niš)
Đorđević Danijela (Klinički centar Niš, Klinika za kardiovaskularne bolesti, Niš)
Background. A prolonged coronary artery spasm with interruption of coronary
blood flow can lead to myocardial necrosis and increase of cardiospecific
enzymes and can be complicated with cardiac rhythm disturbances, syncopc, or
even sudden cardiac death. Case report. A 55-year old male felt a severe
retrosternal pain when exposing himself to cold weather. The pain lasted for
20 minutes and was followed by the loss of conscience. Electrocardiogram
(ECG) showed a complete antrioventricular (AV) block with nodal rhythm and
marked elevation of ST segment in inferior leads. Electrocardiogram was soon
normalized, but serum activities of cardiospecific enzymes were increased.
Coronarography showed normal findings for the left coronary artery and a
narrowing at the middle part of the right coronary artery, which disappeared
after intracoronary application of nitroglycerine. The following therapy was
prescribed: Diltiazem, Amlodipin, Isosorbid mononitrate, Molisdomin,
Atrovastatin, Aspirin and Nitroglycerine spray. After 7 months medicaments
were abandoned and the patient experienced again reccurent chest pain
episodes at rest. Transitory ST segment elevation was recorded in inferior
leads of ECG, but without increase of cardiospecific enzymes serum
activities. After restoration of the medicament therapy anginal episodes
ceased. Conclusion. Coronary dilators in maximal doses can prevent attacks of
vasospastic angina.
Keywords: angina pectoris, variant, vasoconstriction, myocardial infarction, heart block, drug therapy
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