, Sooyoung Cho, Dong Yeon Kim, Seung Hee Yoo Variant angina, which is associated with coronary artery spam, is difficult to recognize on routine preoperative evaluation. Coronary spasm results in myocardial ischemia and even lethal arrhythmia in severe cases. Since patients are unconscious and cannot complain of symptoms during general anesthesia, early detection of such an event is difficult, and it could lead to severe bradycardia or cardiac arrest. We report a case of a patient with previously undiagnosed variant angina who experienced severe hypotension and ventricular fibrillation during general anesthesia.
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, Woo Hee Cho, Do Hyun Lee, Sora Lee, Seong-Hoon Lim Variant angina pectoris is characterized by chest symptoms at rest and transient ST elevation on the electrocardiography due to coronary artery spasm. Although most patients with coronary spasm respond well to medical treatment with vasodilators such as calcium channel blockers and nitrates, some patients show intractable attack of coronary vasospasm despite standard medical therapy. We experienced 50-year-old woman with intractable chest pain due to coronary artery spasm, who suffered from ventricular fibrillation despite continuous intravenous nitrate therapy.
, Kyung Seon Park, Yoo A Choi, Ji Hee Kim, Bu Seok Jeon, Sung Ho Her Arterial remodeling is commonly observed in human atherosclerosis. It is a heterogeneous response ranging from positive remodeling to negative remodeling. Negative remodeling is a condition in which the vessel area decreases in size, often as a result of a structural change in the coronary vessel wall. But its contribution to myocardial ischemia in a de novo lesion has not been clearly shown. A 51-year-old female with exertional angina was admitted to our hospital. Coronary angiography was performed, revealing a severe stenosis at the middle part of the right coronary artery (RCA). Although we predilated ballooning at the middle RCA, the degree of stenosis did not improve. Thus intravascular ultrasound (IVUS) was performed. The lesion was not nearly showed plaque burden and severe negative remodeling. Though the cross-sectional narrowing percentage was significant, we decided to medical treatment for fearing coronary perforation by stenting. This case report intends to emphasize that severe coronary stenosis should be performed IVUS before the stenting. We describe a rare case with severe negative remodeling at the middle part of the RCA without atheroma plaque.
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