Multivessel coronary artery spasm causing myocardial infarction and postinfarction angina.
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Biomedical subjects
Publications and source records attributed to H Ebihara.
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A 47-year-old man presented with angina, and coronary angiograms showed a significant organic stenosis with spasm in the left anterior descending coronary artery. Percutaneous transluminal coronary angioplasty was successfully performed for the organic lesion in the left anterior descending coronary artery. Symptom of angina due to coronary artery spasm recurred, even without restenosis at the site of successful angioplasty.
A case of release of an intracoronary thrombus in a patient with unstable angina is presented. The thrombus was observed in the right coronary artery just distal to the severe stenosis and was released during coronary arteriography.
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The simultaneous occurrences of spontaneous spasm and catheter-induced spasm during coronary angiography were obtained in 3 patients. Catheter-induced spasm was seen in the right coronary artery in 3 patients: 1 patient had spontaneous spasm in the distal right coronary artery and 2 patients had spontaneous spasm in the proximal left anterior descending coronary artery. These findings suggest that patients with variant angina may be susceptible to mechanical induction of spasm.
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The case of a patient with severe left main trunk disease is presented, in which spasm of the right coronary artery resulted in intraoperative myocardial ischemia and perioperative myocardial infarction. It is suggested that coronary spasm may be a cause of perioperative myocardial infarction, and has to be considered in case of unknown etiology.
Sequential changes of gastrointestinal radiology are described in a case of Strongyloides stercoralis hyperinfection. Duodenal dilatation, reflux of barium into the biliary and pancreatic duct, and mucosal thickening of the small intestine were the striking features before treatment. Although treatment with thiabendazole led to rapid and complete clearance of rhabditiform larvae, some abnormal radiologic changes in the small intestine persisted for approximately 4 months before the mucosal pattern reverted to normal.
To detect abnormal interventricular septal (IVS) motion during exercise-induced ischemia, ergometer exercise echocardiography was performed using a specially devised transducer in 12 patients (pts) with effort angina (left anterior descending artery disease) and 10 normal subjects (N) at rest, and during exercise and recovery. During exercise, percent systolic IVS thickening (% delta T) and IVS excursion (Ex) increased from 52 +/- 13% at rest to 73 +/- 19% and from 7.0 /- 1.3 mm at rest to 10.6 +/- 1.9 mm, respectively, in N, and also from 52 +/- 23% to 67 +/- 36% and from 7.3 +/- 1.9 mm to 9.7 +/- 2.1 mm in all of 3 pts with distal left anterior descending artery disease. On the other hand, in 9 pts with proximal left anterior descending artery disease, % delta T and Ex during exercise decreased from 41 +/- 17+ at rest to 26 +/- 25% and from 7.7 +/- 1.2 mm to 5.1 +/- 4.6 mm. The late systolic wall thickening of IVS was observed during peak exercise in 2 of the 9 pts, one of whom exhibited systolic IVS thinning and a decrease in diastolic thickness (from 6 mm to 4.5 mm). In 5 pts with IVS asynergy during exercise diastolic IVS thickness increased maximally from 10.2 +/- 3.3 mm at rest to 11.4 +/- 3.5 mm during recovery (reactive hyperemia). Exercise echocardiography is useful to predict the location of left anterior descending artery disease and to evaluate IVS performance during exercise-induced ischemia.
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