title: [Acute coronary syndrome after diclofenac induced coronary spasm].
abstract: We report about a 67-year old man, who was submitted to our clinic with acute coronary syndrome. The cardiac catheterization showed a proximal thrombus in the left anterior descending (LAD). The other coronary arteries did not have significant lesions. After percutaneous transluminal coronary angioplasty with stent-implantation into the proximal LAD the patient remained clinically stable. Cardiac enzymes confirmed no myocardial necrosis. Three days after the acute coronary syndrome the patient developed a podagra, which was treated with colchicinum, diclofenac and local cooling. Five hours after initial therapy the patient developed severe symptoms of angina pectoris and electrocardiographical signs of an acute posterior and anterior myocardial infarction. Immediate coronary angiography demonstrated extended vasospasm of the right coronary artery. Intracoronary application of verapamil and nitroglycerin resolved the coronary spasm. The patient reported about a self-indicated application of diclofenac six hours before hospital admission. This case demonstrates that oral application of diclofenac can provoke coronary vasospasm.
authors.affiliation: Universitätsklinikum Schleswig Holstein, Campus Kiel, Med. Klinik, Klinik für Kardiologie, Schittenhelmstrasse 12, 24105 Kiel, Germany. Wieckh.@gmx.de
authors.forename: A
authors.initials: A
authors.lastname: Wieckhorst
authors.forename: A
authors.initials: A
authors.lastname: Tiroke
authors.forename: M
authors.initials: M
authors.lastname: Lins
authors.forename: A
authors.initials: A
authors.lastname: Reinecke
authors.forename: G
authors.initials: G
authors.lastname: Herrmann
authors.forename: D
authors.initials: D
authors.lastname: Krüger
authors.forename: R
authors.initials: R
authors.lastname: Simon
mesh_terms: D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D003327:Coronary Disease / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy; D004008:Diclofenac / Q000009:adverse effects* / Q000627:therapeutic use; D006073:Gout / Q000188:drug therapy; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac