title: Coronary Pan-Ischemia as a First Sign of a Fulminant Host-Versus-Graft Reaction Eight Years After Orthotopic Heart Transplantation.
abstract: Acute graft rejection in patients after heart transplantation can cause arrhythmias and acute angina pectoris with electrocardiographic ST-segment elevation. We report a case of a 53-year old female patient who had undergone cardiac transplantation 8 years previously. She developed bradycardia with co-existent ST-segment elevation caused by a histologically proven acute graft rejection. After administration of methylprednisolone and immune absorption leading to initial clinical improvement, the patient died unexpectedly. The reasons remain unclear, but a degeneration of the conduction system as well as impaired blood flow in the right coronary caused by cellular and humoral rejection most likely have both contributed.
authors.affiliation: 1st Medical Department - Cardiology, Linz General Hospital, Johannes Kepler University Linz School of Medicine.
authors.forename: Juergen
authors.initials: J
authors.lastname: Kammler
authors.forename: Hermann
authors.initials: H
authors.lastname: Blessberger
authors.forename: Alexander
authors.initials: A
authors.lastname: Kypta
authors.forename: Michael
authors.initials: M
authors.lastname: Lichtenauer
authors.forename: Alexander
authors.initials: A
authors.lastname: Nahler
authors.forename: Thomas
authors.initials: T
authors.lastname: Lambert
authors.forename: Klaus
authors.initials: K
authors.lastname: Aumayr
authors.forename: Andreas
authors.initials: A
authors.lastname: Zuckermann
authors.forename: Clemens
authors.initials: C
authors.lastname: Steinwender
mesh_terms: D001919:Bradycardia / Q000175:diagnosis / Q000209:etiology; D004562:Electrocardiography / Q000379:methods; D017809:Fatal Outcome; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D012720:Severity of Illness Index