title: Refractory vasospasm with a malignant course.
abstract: We present a patient with two rare disorders, recurrent vasospastic angina leading to cardiac transplant and acute aortic occlusion. The patient had recurrent episodes of coronary vasospasm presenting with unstable angina, acute myocardial infarction, and sudden cardiac death in spite of adequate therapy with nitrates and calcium-channel blockers. He went on to have a cardiac transplant. The patient later presented with acute aortic occlusion with concomitant renal and mesenteric artery spasm. The circumstances of the presentation raise the possibility of a generalized vasospastic predisposition that is responsible for both events. Smoking, the only known major risk factor other than atherosclerosis, was noted to be temporally related to both events in our patient.
authors.affiliation: Department of Cardiology, Michael Reese Hospital and Medical Center, Chicago, Illinois 60616, USA.
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.forename: H
authors.initials: H
authors.lastname: Chandna
authors.forename: V
authors.initials: V
authors.lastname: Santhanam
authors.forename: P
authors.initials: P
authors.lastname: Denes
mesh_terms: D000208:Acute Disease; D000789:Angina, Unstable / Q000209:etiology; D001018:Aortic Diseases / Q000209:etiology; D001157:Arterial Occlusive Diseases / Q000209:etiology; D003329:Coronary Vasospasm / Q000209:etiology*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008638:Mesenteric Arteries; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D012008:Recurrence; D012077:Renal Artery; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013035:Spasm / Q000209:etiology*