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Patient Vasospasm Case Study

Satisfactory Essays
1. Wraparound LAD:
2. Transient vasospasm
3. Microvascular dysfunction-
4. Mid ventricular obstruction, apical stunning

Pathophysiology: The exact pathophysiology is unknown but it could be due to stress induced catecholamine release. Apical portion of LV has highest concentration of sympathetic innervation which may explain increase in catecholamine level affects LV function. Neuro hormonal stimulation by catecholamine results in acute myocardial dysfunction may be triggered by multi vessel spasm, thrombosis, epidural vessel occlusion, or direct myocardial injury.

Pertinent Findings:
Most patients present with complaint of acute substernal chest pain but some may present with dyspnea or syncope. Some patients develop sign and symptoms of
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ST depression less common findings.
Sometimes may present with QT interval prolongation, T wave inversion or abnormal Q waves.

Cardiac biomarkers: troponin typically moderately elevated while CK-MB normal or mildly elevated in SICM

Brain natriuretic peptide (BNP) or pro- BNP levels are elevated.

Mayo clinic diagnostic criteria, all four of which are required for the diagnosis:

- Transient hypokinesis, akinesis or dyskinesis of the left ventricular mid segments with or without apical involvement.
- Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture.
- New ECG abnormalities (either ST segment elevation and/or T wave inversion) or modest elevation in cardiac troponin
- Absence of pheochromocytoma or myocarditis

Thus, a diagnosis of TCM generally requires coronary angiography, serial assessment of LV systolic dysfunction, an ECG and cardiac troponin level.

Management with treatment:
- Overall treatment is supportive and conservative.
- Left ventricular function is treated with diuretics, beta blockers and ACEI as heart failure management.
- Beta blockers may block catecholamine excess which is potential mechanism of
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