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At least 685 records · Page 38Linked to original sources
PubMed2000

Encephalopathy with epileptic spasms resolved with corticoids in a 69 year-old patient.

A 69 year-old man with a history of recent temporal lobe seizures, presented with progressive coma and frequent epileptic spasms. Ictal EEG, PET and SPECT alterations were strikingly similar to those described in infantile spasms. Conventional antiepileptic drugs were ineffective but the introduction of corticoids induced a dramatic improvement with disappearance of the spasms. The etiology remains unknown. Epileptic spasms may occur in the elderly. If conventional antiepileptic drugs are ineffective, corticoids should be tried immediately.

Aged↗
PubMed2001

[A case of refractory spasm of multiple coronary arteries and left internal thoracic artery graft following off-pump CABG].

A 61-year-old man with exertional angina was underwent off-pump CABG with left internal thoracic artery being constructed to his left anterior descending artery. Two hours after surgery, complete atrioventricular block developed with circulatory collapse. Emergency cardiac catheterization showed multiple coronary artery spasms and LITA graft spasm, which were refractory to intracoronary and intragraft nitroglycerin injection. So we established IABP and continuous hemofiltration (CHF) urgently. Thereafter, his hemodynamics gradually improved and spasm did not recur. His postoperative angiogram revealed no significant narrowing in coronary arteries and patent anastomosis. IABP and CHF might be one of useful procedure for refractory postoperative coronary spasm.

Angina Pectoris↗
PubMedDate not supplied

[Electroencephalographic reflection of arterial spasm following surgery for saccular cerebral aneurysms].

The purpose of the investigation was to study the electrophysiological manifestations of arterial spasm developing following surgical interventions for cerebral arterial aneurysms. Repeated EEG-recording was undertaken for this purpose in 40 patients with aneurysms of different localization. The EEG data were compared with the results of a neurological examination and angiography performed pre- and postoperatively. It was found that with an uneventful postoperative course no focal changes develop in the bioelectrical activity, and EEG returns to the initial (preoperative) state or to the normal pattern as soon as by the 15th-20th day. In the presence of postoperative arterial spasm, verified clinically and angiographically, the latter is reflected in EEG tracings as peculiar focal changes in the biopotentials. These changes have a nature of a periodically occurring delta-activity recorded predominantly in the zone of ischaemia. Along with a regress of the spasm its EEG manifestations were found to decrease as well. The focal EEG changes observed in postoperative spasm differ from the localization of those EGG changes that are caused by other factors (haematoma, cicatrical processes, etc.).

Adult↗
PubMed2003

Prevention of radial artery graft spasm: a survey of Canadian surgical centres.

BACKGROUND: The radial artery (RA) is used as an alternative conduit to the traditional saphenous vein bypass graft in some cardiac surgery centres. Despite limited clinical trial data, many centres appear to be using routine drug therapy to prevent spasm of the RA graft in the immediate and late postoperative period. OBJECTIVES: To determine the proportion of patients in Canadian cardiac surgery centres having RA bypass grafts and the percentage of patients routinely receiving drug therapy to prevent spasm of these grafts. METHODS: A questionnaire was sent to all cardiac surgery centres in Canada requesting data for the year 2000 on the total number of bypass surgery operations and the number of patients having RA bypass grafts. Information on approaches taken toward prophylaxis against spasm of RA grafts was also requested. RESULTS: The use of RA grafts ranged between 1% and 50%. Twenty-five of 27 centres used antispasm prophylaxis with calcium channel blockers with or without long acting nitrates both in the intensive care unit and on the surgical ward. Calcium channel blockers were prescribed routinely in all 25 centres with 12 centres also using long acting nitrates. Only two centres routinely continued nitrates on the ward. The duration of antispasm therapy varied from several weeks up to six months. CONCLUSIONS: Prophylaxis against spasm of RA grafts is practised in over 95% of Canadian surgical centres despite limited clinical outcome data to support this practice.

Calcium Channel Blockers↗
PubMedDate not supplied

[Prolonged spasm of the arteries of the base of the brain during experimental fibrinolysis in the subarachnoid space].

An ex tempore mixture of fibrinogen (1%--4 ml) and 0.2 ml thrombin solutions forming a compact clot of fibrin in the subarachnoid space was introduced into the cisterna magna of dogs. To dissolve the fibrin clot 2 ml of a fibrinolysin solution with an activity of 400 units were introduced into the same cisterna 10--15 minutes thereafter. A total of 26 experiments were set up, of which 13 were served as controls with separate introduction of the mixture ingredients. Through serial vertebral angiography with a 50 per cent urotrast solution it was found that following introduction of the fibrinogen and thrombin mixture the lumen of the basilar artery and of its branches contracts on the average up to 89.2 +/- 1 per cent. After introduction of fibrinolysis the diameter of the artery initially increases up to 116.3 +/- 2.5 per cent. In 3 hours time a pronounced spasm of the basilar artery and of its branches is seen to develop up to 80.9 +/- 3.6 per cent and after 24 hours -- up to 73.9 +/- 2.1 per cent. The spasm persists for up to 10 days, but its intensity gradually declines. During subsequent 11--18 days the diameter of the brain base arteries returns back to normal. In control experiments no development of protracted spasm was demonstrated. Hence, it is established that the appearance of fibrinolysis products formed in the spinal fluid consequent upon dissolution of a clot of fibrin containing no blood cells is attended by the development of a protracted spasm involving major arteries of the brain.

Animals↗
PubMed1992

[A case of painless myocardial injury probably caused by coronary artery spasm].

A 53-year-old male was admitted to the hospital due to electrocardiographic ST-segment elevation in V1-4 with ST-segment depression in the inferior leads, which suggested acute myocardial infarction. He had a cough and a slight fever without chest pain. Serum creatine kinase and its myocardial band were slightly elevated but creatine kinase value did not exceed twice the normal upper limit. Emergent coronary arteriography (CAG) revealed intact coronary arteries. The CAG in a chronic stage again revealed intact coronary arteries. Intracoronary administration of acetylcholine of 100 micrograms to the left coronary artery and 50 micrograms to the right coronary artery provoked diffuse spasm in the right and left coronary arteries. The electrocardiogram (ECG) during the right coronary artery spasm revealed ST-segment depression in the inferior leads with ST-segment elevation in V2 and V3, which resembled the ECG finding at the time of the patient's admission. With intracoronary isosorbide dinitrate, the spasm and ST-segment elevation were resolved. These findings strongly suggest that coronary spasm can cause myocardial injury indicated by a slight elevation of serum creatine kinase value.

Coronary Angiography↗
PubMed1992

[Histological evidence of prolonged coronary artery spasm in a necropsy case of recurrent myocardial infarction].

A 69-year-old male had acute inferior infarction during an operation of an aneurysm of the abdominal aorta and died from multiple organ failure 3 weeks after the operation. His initial coronary angiogram (CAG) showed no significant stenosis, but repeated CAG showed that the patients had developed a prolonged spasm in the mid-portion of the right coronary artery. Histologically, we observed eccentric luminal narrowing with atheromatous plaque where the spasms had been demonstrated, and a "waving form" of elastic fibers accompanied by intimal thickening in the opposite site of the atheromatous plaque. These findings suggest that organic stenosis may be underestimated angiographically because of compensatory enlargement of the non-atheromatous site in some patients with coronary artery spasm, and prolonged spasms may augment organic stenosis by following intimal thickening.

Aged↗
PubMed1992

[Coronary artery spasm during coronary artery bypass surgery].

We report two cases of coronary artery spasm during coronary artery bypass surgery. As one of the complications during cardiac surgeries, coronary vasoconstriction occurs mainly after coming off cardiopulmonary bypass. The factors responsible for the spasm include high endogenous catecholamine levels due to inadequate anesthesia and hypothermia, exogenous catecholamines for circulatory support, various chemical mediators and combination of these factors. Coronary artery spasm was suspected strongly because of sudden ischemic change in electrocardiography and simultaneous aggravation of circulatory parameters, which improved immediately after direct injection of coronary vasodilators into vein graft. This method, popular in coronary angiography and catheterization, is effective for release of coronary-artery spasm observed particularly after cardiopulmonary bypass. Then mechanical circulatory assist is readily available to treat possible systemic side effect of the vasodilators.

Coronary Artery Bypass↗
PubMed2004

[Intraoperative coronary spasm in patients without a history of anginal chest pain].

We report three cases of intraoperative coronary spasm that developed during non-cardiac surgical procedures. None of the patients had a history of anginal chest pain. The presumed contributing factors were: 1) suction of the trachea during general anesthesia, 2) hyperventilation and hypotension during induction of general anesthesia, and 3) hyperventilation during neuroanesthesia. Coronary vasodilators were administered and all cases recovered promptly without any clinical sequelae. A review of the literature reveals that the majority of patients who developed intraoperative coronary spasm had no history of anginal chest pain. Some of common intraoperative conditions such as hyperventilation, hypotension, and inadequate depth of anesthesia, were reported to be potent precipitating factors for coronary spasm. In recent years, a larger proportion of surgical patients have coronary risk factors. Careful anesthetic management is required to prevent intraoperative coronary spasm even in patients without a history of coronary artery disease.

Aged↗
PubMedDate not supplied

Severe lymphocytic endothelialitis associated with coronary artery spasm in a heart transplant recipient.

Coronary artery spasm plays an important role in ischemic heart disease, particularly variant angina. We report the case of a 59-year-old man who developed severe diffuse coronary artery spasm 11 months after he received a heart transplant. The spasm was reversed by a single dose of sublingual nitroglycerin; however, the patient died 9 days later of Pneumocystis carinii pneumonia. Postmortem examination of this patient's heart revealed accelerated arteriosclerosis, with a prominent diffuse lymphocytic endothelialitis in the coronary arteries. The lymphocytic endothelialitis was characterized by the presence of numerous T lymphocytes and macrophages in the subendothelial space and by histologic changes suggesting injury to the endothelial cells. Although an association does not prove a causal relationship, the findings of accelerated arteriosclerosis and lymphocytic endothelialitis in a patient with coronary artery spasm suggests that these processes may be etiologically linked.

Coronary Artery Disease↗
PubMed1992

[Spasm of the left main coronary artery resistant to intracoronary vasodilators. Apropos of a case].

Coronary spasm is essentially and angiographic diagnosis. Catheter-induced spasm is frequent during coronary angiography and usually regresses after the administration of intracoronary vasodilators. The authors report a case of coronary spasm with subocclusion of the left main coronary artery: the coronary narrowing remained significant after intracoronary vasodilator therapy, suggesting an organic component. The spasm was relieved only after a prolonged intravenous infusion of isosorbide dinitrate.

Angina Pectoris, Variant↗
PubMed1992

[Coronary spasm-induced acute myocardial infarction associated with intracoronary thrombosis].

A 63-year-old man was admitted with an acute anteroseptal myocardial infarction. Coronary angiography performed 3 hours after the onset of chest pain revealed 99% stenosis of the proximal left anterior descending coronary artery (LAD) with delayed filling and intraluminal thrombus distal to the stenosis. After the intracoronary injection of isosorbide dinitrate, the delayed filling disappeared and a subsequent intracoronary urokinase partially dissolved the thrombus. Repeat coronary angiography in the chronic phase disclosed 75% stenosis of the LAD and disappearance of the thrombus. Intracoronary acetylcholine provoked a coronary spasm at the stenotic site of the LAD, concomitantly with chest pain and ST-segment elevation in the anterior leads. The present case demonstrated that coronary spasm plays an important role in thrombus formation and acute myocardial infarction. To date, the concept has been postulated that a dynamic interaction between atherosclerosis, platelet aggregation and spasm may work to cause coronary thrombosis and subsequently lead to acute myocardial infarction. Our report shed light on the importance of coronary spasm in the pathogenesis of myocardial infarction.

Acetylcholine↗
PubMedDate not supplied

[Diagnosis of middle cerebral artery spasm by determination of flow velocity and the Lindegaard index with transcranial color Doppler sonography].

BACKGROUND AND PURPOSE: Recent reports have demonstrated the high utility of transcranial color-coded duplex sonography (TCCS) in the diagnosis of advanced spasm of the middle cerebral artery, whereas its accuracy in the diagnosis of mild vasospasm is reported to be lower. Relation of blood flow velocity in the middle cerebral artery (MCA) to that in the extracranial internal carotid artery (VMCA/VICA index) is recommended as being helpful in the diagnosis of vasospasm (the so called Lindegaard Index). Nevertheless, the exact diagnostic value of this index using the TCCS method remains to be established. The purpose of this study is to estimate the accuracy of TCCS in the diagnosis of MCA vasospasm, as based on the VMCA/VICA index. MATERIAL AND METHODS: The VMCA/VICA index was calculated in 195 patients (285 middle cerebral arteries) who were scheduled for cerebral arteriography. The TCCS study and color-coded duplex sonography of the internal carotid arteries were performed immediately before arteriography. RESULTS: A mild grade of MCA spasm was diagnosed angiographically in 21, and moderate-to-severe spasm in 29 MCAs out of 285 successfully insonated arteries. Peak-systolic, mean and end-diastolic blood velocities were measured using transcranial color sonography in the MCA and related to the respective velocities in the ipsilateral extracranial internal carotid artery. Receiver-operating characteristic curves (ROC) were calculated for particular velocities and for the related VMCA/VICA indices. By comparison of the areas under the ROC curves it was shown that the use of the VMCA/VICA index does not improve the accuracy of TCCS in the diagnosis of advanced MCA spasm, whereas it improves accuracy in the diagnosis of mild vasospasm. In particular, accuracy can be improved by the use of the VMCA/VICA index based on the end-diastolic velocity. The optimal diagnostic threshold of the VMCA/VICA index was determined at 3.9. CONCLUSIONS: The use of VMCA/VICA index improves the accuracy of TCCS in the diagnosis of mild vasospasm of the middle cerebral artery.

Adult↗
PubMed2005

Cardiogenic shock caused by severe coronary artery spasm immediately after coronary stenting.

Coronary artery spasm is common during percutaneous coronary intervention and is easily relieved by intracoronary administration of vasodilators. We report the case of a patient who had severe, protracted, generalized spasm of the entire left coronary artery system during coronary artery stenting. The spasm, which was unresponsive to intracoronary vasodilators administered via guiding catheter, resulted in pulmonary edema and cardiogenic shock. Local injection of nitroglycerin via a transit catheter in the coronary artery eventually resolved the spasm and reversed the cardiogenic shock. To our knowledge, this is the 1st report of such a case in the English-language medical literature.

Aged↗
PubMed1992

[Successfully treated intraoperative coronary artery spasm in a patient with type B dissecting aortic aneurysm: a case report].

A 65-year-old man with chronic type B dissecting aortic aneurysm, complicated by variant from of angina pectoris without any coronary artery obstructed disease on preoperative angiogram was operated upon through left posterolateral thoracotomy under the left heart bypass with Bio-pump system using preoperative Ca antagonists and intraoperative nitroglycerin infusion. Shortly before the end of operation the patient suddenly developed shock status definitely due to coronary artery spasm, associated with ST-elevation in II, III, aVF and bradycardia, then ventricular tachycardia, finally cardiac arrest. The patient was resuscitated by cardiac massage and administration of nifedipine and nitroglycerin. Such attacks repeated five times at ten or twenty minutes intervals. The coronary artery spasm could be successfully suppressed with the additive use of noradrenaline infusion. The patient had no attacks at all postoperatively and was discharged with good success. This case suggests that the prevention of intraoperative coronary artery spasm is essential, but if it occurs, additive use of noradrenaline infusion is effective for the cessation of coronary artery spasm.

Aged↗
PubMed1991

[Myocardial bridge of the left anterior descending coronary artery and myocardial infarction: does coronary spasm play a part?].

The association of a myocardial bridge of the left anterior descending (LAD) coronary artery and myocardial infarction is rare. The mechanisms by which the myocardial bridge could predispose to myocardial infarction are tachycardia (reducing the duration of diastolic coronary filling), thrombosis at the site of the myocardial bridge, and coronary spasm which, however, has never been demonstrated in the context of infarction. The aim of this study was to detect coronary spasm by provocative ergometrine testing in 4 patients, all male, aged 21 to 49 years, average 39 years old, who had anterior myocardial infarction associated with myocardial bridging of the LAD artery without atheromatous coronary stenosis. The ergometrine tests were performed during (2 cases) or after coronary angiography (2 cases). The systolic narrowing due to the myocardial bridge ranged from 25 to 95% (average 70%). The ergometrine test was strongly positive in 1 patient and negative in the other 3. Repermeabilisation of a thrombus was suggested in these 3 patients by the recording of an accelerated idioventricular rythm in the acute phase of infarction (2 cases) or by the demonstration of abnormal platelet aggregation (1 case). This is the first report of coronary spasm in a patient with myocardial bridging associated with infarction. However, it is not possible to determine the respective roles of spasm and myocardial bridging in the genesis of the infarct. We suggest systemic provocative ergometrine testing in this situation to orientate the most appropriate treatment.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Coronary artery spasm in heart transplant recipients.

Coronary artery spasm has rarely been observed in the transplanted, denervated heart. We report two patients who had coronary artery spasm after orthotopic heart transplantation that was documented by coronary angiography while ECG and Holter monitoring showed ischemic changes. Both patients were treated with calcium antagonists with no further evidence of this complication; however, one patient died suddenly at home after calcium antagonists were arbitrarily withdrawn. We believe that coronary artery spasm in heart transplant recipients may occur more frequently than expected. Careful monitoring of 24-hour ECG should be considered routinely in the follow-up of such patients, and when coronary spasm occurs it should be aggressively treated.

Adult↗
PubMedDate not supplied

Prevention of coronary spasms during aorto-coronary (A-C) bypass surgery for variant angina and effort angina with ST-elevation.

Aorto-coronary (A-C) bypass surgery was carried out in 15 cases of Prinzmetal's angina and effort angina with ST-elevation, commonly ascribed to coronary vasospasms. A-C bypass surgery is usually indicated for vasospastic angina when there are significant organic lesions of the coronary arteries. Fifty mg of verapamil was added to the priming solution for cardiopulmonary bypass, and A-C bypass surgery was successfully performed without the occurrence of perioperative coronary spasms even though severe episodes of spasm had been documented before surgery. However, four cases of vasospastic angina not receiving verapamil developed coronary spasms during or after A-C bypass surgery. It was concluded that administration of verapamil, a potent calcium entry blocking agent, is effective in preventing perioperative coronary vasospasms. Patency of the saphenous vein grafts bypassing the spasm-related coronary arteries was satisfactory.

Adult↗