The paradox of 'chronic unstable angina' secondary to an organizing intracoronary thrombus.
We have described a case in which coronary vasospasm and the resultant endothelial shear stresses most likely caused plaque rupture and transient coronary occlusion at the site of a minor atherosclerotic narrowing. Remodeling then led to a long, complex stenotic lesion that included ruptured and dissected endothelium and organized thrombus. This led to severe anginal symptoms over a 3-month period, or the paradox of "chronic unstable angina." Angioplasty was difficult but eventually successful after pulsed high-pressure balloon inflations and intracoronary thrombolytic therapy with streptokinase. This case demonstrates that the clinical course of a patient with minor or insignificant coronary disease may be a dynamic process that cannot be entirely predicted even by recent invasive cardiac studies.
Houghton
J L
JL
Section of Cardiology, Medical College of Georgia, Augusta 30912.
Albazzaz
S J
SJ
Frank
M J
MJ
D000789:Angina, Unstable / Q000209:etiology*; D000800:Angioplasty, Balloon; D006328:Cardiac Catheterization; D002908:Chronic Disease; D003328:Coronary Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D003329:Coronary Vasospasm / Q000150:complications; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D012422:Rupture, Spontaneous