Obrzęk płuc w przebiegu spazmu pnia lewej tętnicy wieńcowej u 50-letniej kobiety z naczynioskurczową postacią dławicy piersiowej

Streszczenie

Variant angina is a form of angina pectoris that shows transient ST-segment elevation on electrocardiogram during an attack of chest pain. Coronary artery spasm is the general mechanism of ischemic episodes in variant angina. Deficient basal release of nitric oxide (NO) due to endothelial dysfunction, and enhanced vascular smooth muscle contractility with the involvement of the Rho-kinase pathway are considered to play important roles in the pathogenesis of coronary artery spasm. Smoking cigarettes is regarded as the major triggerring factor. Calcium channel blockers are extremely effective in preventing coronary spasm. The long-acting nitrates, nicorandil, and Rho-kinase inhibitors are also efficient. Incidence of severe arrhytmias, including ventricular tachycardia, ventricular fibrillation, and high-degree atrioventricular block often requires implementing interventional methods of therapy. This article presents a case of variant angina complicated by pulmonary oedema. Due to recurrent episodes of left ventricular circulatory failure associated with the coronary vasospasm, farmacological treatment, including high doses of calcium-channel blockers and long-acting nitrates, was implemented. No further symptoms of angina were reported on optimal therapy.