Anomalous left main coronary artery origin, silent ischaemia, risk of sudden death: a triad detected by combining coronary CT and dipyridamole SPECT
Sudden death is often the first manifestation of ALMCO. 2 In this patient, the aortic root dilation may have compressed the acute angle take off of the RCA, inducing a dynamic stenosis. 3 Perfusion may have then become dependent on collaterals. [...]dipyridamole-induced flow steal from RCA collatera...
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| Veröffentlicht in: | BMJ case reports 2013-08, Vol.2013, p.bcr2013200129 |
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| creator | Carboni, Gian Piero Sedati, Pietro De Marco, Emidio |
| description | Sudden death is often the first manifestation of ALMCO. 2 In this patient, the aortic root dilation may have compressed the acute angle take off of the RCA, inducing a dynamic stenosis. 3 Perfusion may have then become dependent on collaterals. [...]dipyridamole-induced flow steal from RCA collaterals could not be ruled out for the genesis of the septal-inferior wall ischaemia. 4 In ALMCO, the decision for surgery must be balanced between the risk of sudden death decreasing with age, the presence of symptoms and the ischaemic territory involved. 5 As ischaemia was mild and asymptomatic, we decided to increase the patient's myocardial protection with [beta]-blockers and set up a simple annual surveillance. |
| doi_str_mv | 10.1136/bcr-2013-200129 |
| format | Article |
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| subjects | Aged Coronary Vessel Anomalies - complications Coronary Vessel Anomalies - diagnosis Coronary vessels Death, Sudden, Cardiac - etiology Dipyridamole Europe (West) Heart attacks Humans Images In Ischemia - complications Ischemia - diagnosis Male Multimodal Imaging Pulmonary arteries Risk Factors Tomography, Emission-Computed, Single-Photon Tomography, X-Ray Computed Vasodilator Agents Veins & arteries White |
| title | Anomalous left main coronary artery origin, silent ischaemia, risk of sudden death: a triad detected by combining coronary CT and dipyridamole SPECT |
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