Tekrarlayan Miyokard Enfarktüsü ile Gelen Vazospastik Angina Hastasının Zorlu Tedavi Süreci: Literatür Gözden Geçirilmesi
Özet
Vazospastik angina (VSA), koroner arterlerde geçici darlığa yol açan damar aşırı duyarlılığı ile karakterize, nadir bir kalp kökenli göğüs ağrısı türüdür. Genellikle kalsiyum kanal blokerleri ve nitratlar gibi tıbbi tedavilerle kontrol altına alınabilse de bazı vakalar tedaviye direnç gösterebilir; bu durum akut koroner sendromlara, tekrarlayan miyokard enfarktüslerine ve ölümcül aritmi risklerine yol açarak prognozu kötüleştirebilir. Bu çalışmada, optimal medikal tedaviye rağmen tekrarlayan ST elevasyonlu miyokard enfarktüsü ve ventriküler fibrilasyona bağlı kardiyak arrest geçiren 37 yaşında bir erkek hastanın zorlu klinik süreci sunulmuştur. Hastaya ikincil koruma sağlamak amacıyla implante edilebilir defibrilatör (İKD) takılmış, ancak semptomların devam etmesi üzerine dirençli vazospazm görülen sağ koroner arter, sirkumfleks arter ve sol ön inen arter bölgelerine ilaç salınımlı stentler yerleştirilmiştir. Stent implantasyonu sonrasında hastanın angina atakları durmuş, dört aylık takipte yeni bir epizot veya aritmi kaydına rastlanmamıştır. VSA'nın patogenezinde düz kas hiperreaktivitesi, endotel disfonksiyonu ve sigara gibi tetikleyiciler rol oynamaktadır. Bu vaka, standart tıbbi tedaviye dirençli, hayati tehlike oluşturan vazospastik angina olgularında perkütan koroner girişim ile stent yerleştirilmesinin ve İKD uygulamasının hayat kurtarıcı ve etkili bir alternatif tedavi stratejisi olabileceğini göstermektedir.
Vasospastic angina (VSA) is a rare form of cardiac chest pain characterized by coronary artery hyperreactivity that leads to transient arterial narrowing. Although most patients respond well to medical therapies including calcium channel blockers and nitrates, some cases remain refractory, increasing the risk of acute coronary syndromes, recurrent myocardial infarctions, fatal arrhythmias, and poor prognosis. This study presents a challenging treatment process of a 37-year-old male patient who suffered from recurrent ST-elevation myocardial infarctions and ventricular fibrillation-induced cardiac arrest despite receiving optimal medical therapy. For secondary prevention, an implantable cardioverter-defibrillator (ICD) was implanted; however, due to persistent ischemic episodes, drug-eluting stents were successfully deployed into the spastic segments of the right coronary, circumflex, and left anterior descending arteries. Following stent implantation, the patient's anginal attacks ceased, and no further spastic episodes or arrhythmic events were recorded during a four-month follow-up. The pathogenesis of VSA involves vascular smooth muscle hyperreactivity, endothelial dysfunction, and triggers like smoking. This case demonstrates that percutaneous coronary intervention with stent deployment, combined with ICD implantation, serves as an effective and life-saving therapeutic strategy for patients with medically refractory and life-threatening vasospastic angina.
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