Ramazan AKDEMİR, Harun KILIÇ, Sadık AÇIKEL, Münevver SARI

A case of anomalous origin of circumflex coronary artery and slow coronary flow mimicking ST-elevation myocardial infarction

Koroner arter anomalileri akut koroner sendromların nadir nedenlerinden biridir. Koroner arter anomalilerinin tanınarak uygun sınıflandırılmasının başlıca amacı koroner arter anomalilerinin miyokardiyal iskemiye neden olabilmesidir. Yavaş koroner akım da miyokardiyal iskeminin nedenlerinden biri olarak bilinmektedir. Yazımızda tipik göğüs ağrısı ile başvuran ve elektrokardiyografide inferior derivasyonlarda ST yükselmesi, ekokardiyografisinde inferior duvar hipokinezisi saptanan 38 yaşında erkek hastayı sunmaktayız. Hasta yüksek riskli akut koroner sendrom şüphesi ile primer perkütan koroner girişimle mekanik revaskülarizasyon için kateter laboratuvarına alındı. Ancak koroner anjiyografide inferior derivasyonlarda ST elevasyonu ve dinamik ST-T değişikliklerinin nedeni olarak ciddi koroner arter hastalığı veya koroner arter trombozu olmaksızın sirkumfleks koroner arterin sağ sinüs valsalvadan çıkış anomalisi ve sirkumfleks koroner arterde koroner yavaş akım olduğu gösterildi. ST yükselmeli miyokard infarktüsü ve yavaş koroner akımın tedavisindeki farklılıklar nedeniyle, vakamız ST yükselmeli miyokard infarktüsü tedavisinde önemli yeri olan trombolitik ve/veya mekanik revaskülarizasyon tedavileri uygulanmaksızın medikal olarak izlenmiştir.

ST yükselmeli miyokard infarktüsünü taklit eden sirkumfleks koroner arter çıkış anomalisi ve yavaş koroner akım olgusu

Coronary artery anomalies are one of the rare reasons of acute coronary syndromes. The major reason for appropriately identifying and classifying coronary anomalies is to determine their propensity to develop myocardial ischemia. Slow coronary flow is also known as one of the reasons of myocardial ischemia. In this case report, we present a 38 year old man presented with typical prolonged rest angina accompanying by inferior ST elevation in electrocardiography and inferior wall hypokinesis in echocardiography. He was taken catheterization laboratory for mechanical coronary revascularization with primary percutaneous coronary intervention due to the suspicion of high risk acute coronary syndrome. However, coronary angiography revealed that the anomalous origin of the circumflex coronary artery from the right sinus valsalva and coronary slow flow of circumflex coronary artery as a cause of inferior ST segment elevation and dynamic ST-segment-T wave changes with no evidence of significant obstructive coronary artery disease or thrombosis. Because of the treatment modalities in both STEMI and slow coronary flow are so different, we followed patient medically without pharmacological, and/or mechanical coronary revascularization which are the cornerstones in the treatment of the ST-segment elevation myocardial infarction.

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