Article metrics

  • citations in SCindeks: 0
  • citations in CrossRef:0
  • citations in Google Scholar:[=>]
  • visits in previous 30 days:7
  • full-text downloads in 30 days:0
article: 10 from 18  
Back back to result list
Vojnosanitetski pregled
2014, vol. 71, iss. 11, pp. 1066-1071
article language: English
document type: Case Report
published on: 17/11/2014
doi: 10.2298/VSP1411066P
Syncope as initial symptom of ostial lesion of the left main coronary artery with cardiogenic shock
aUniversity of Novi Sad, Faculty of Medicine, Institute for Cardiovascular Disease + University of Novi Sad, Faculty of Medicine
bUniversity of Novi Sad, Faculty of Medicine + University of Novi Sad, Faculty of Medicine, Institute for Cardiovascular Disease



Introduction. Syncope represents a relatively atypical symptom of acute coronary syndrome. Syncope itself does not provide enough information to indicate an acute coronary event, especially a lesion of the left main coronary artery, without malignant rhythm and conduction disorders. Case report. A male patient, aged 63, was admitted to the intensive cardiac care unit because of a short loss of consciousness, in sinus tachycardia, with signs of acute heart failure and being hypotensive. Electrocardiogram showed a possible acute anterior myocardial infarction, followed by cardiogenic shock and emergency coronary angiography (subocclusive ostial lesion of the left main coronary artery) and primary percutaneous coronary intervention with intraaortic balloon pump therapy was performed. A direct drug eluting stent was implanted with the optimal primary result. Conclusion. The prompt diagnosis, especially in such relatively atypical clinical presentation, reperfusion therapy with primary percutaneous coronary intervention in acute myocardial infarction complicated by cardiogenic shock, contribute to the improvement in the survival rate and patient's quality of life. This case report is clinically educative due to relatively atypical presentation and performed interventions.



Bahekar, A., Singh, M., Singh, S., Bhuriya, R., Ahmad, K., Khosla, S., Arora, R. (2012) Cardiovascular outcomes using intra-aortic balloon pump in high-risk acute myocardial infarction with or without cardiogenic shock: a meta-analysis. J Cardiovasc Pharmacol Ther, 17(1): 44-56
Chieffo, A., Park, S.J., Valgimigli, M., Kim, Y.H., Daemen, J., Sheiban, I., Truffa, A., Montorfano, M., Airoldi, F., Sangiorgi, G., Carlino, M., Michev, I., Lee, C.W., Hong, M.K., Park, S.W., Moretti, C., Bonizzoni, E., Rogacka, R. (2007) Favorable Long-Term Outcome After Drug-Eluting Stent Implantation in Nonbifurcation Lesions That Involve Unprotected Left Main Coronary Artery: A Multicenter Registry. Circulation, 116(2): 158-162
de Backer, D., Biston, P., Devriendt, J., Madl, C., Chochrad, D., Aldecoa, C., Brasseur, A., Defrance, P., Gottignies, P., Vincent, J. (2010) Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med, 362(9): 779-89
Fihn, S.D., Gardin, J.M., Abrams, J., i dr. (2012) 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients with Stable Ischemic Heart Disease. Circulation, 126(25): 3
French, J.K., Feldman, H.A., Assmann, S.F., Sanborn, T., Palmeri, S.T., Miller, D., Boland, J., Buller, C.E., Steingart, R., Sleeper, L.A., Hochman, J.S. (2003) Influence of thrombolytic therapy, with or without intra-aortic balloon counterpulsation, on 12-month survival in the SHOCK trial. Am Heart J, 146(5): 804-10
Kushner, F.G., Hand, M., Smith, S.C., King, S.B., Anderson, J.L., Antman, E.M., Bailey, S.R., Bates, E.R., Blankenship, J.C., Casey, D.E., Green, L.A. (2009) 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (updating the 2005. Circulation, 120(22): 2271-306
Lee, M.S., Bokhoor, P., Park, S.J., i dr. (2010) Unprotected left main coronary disease and ST-segment elevation myocardial infarction: a contemporary review and argument for percutaneous coronary intervention. J Am Coll Cardiol Intv, 3(8): 791
Lemonick, D.M. (2010) Evaluation of Syncope in the emergency department. Am J Clin Med, 7(1): 11-1
Levine, G.N., Bates, E.R., Blankenship, J.C., i dr. (2011) 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. J Am Coll Cardiol, 58(24): 25
McDermott, D., Quinn, J.V., Murphy, C.E. (2009) Acute myocardial infarction in patients with syncope. CJEM, 11(2): 156-60
Morice, M., Serruys, P.W., Kappetein, P.A., Feldman, T.E., Ståhle, E., Colombo, A., Mack, M.J., Holmes, D.R., Torracca, L., Es, G., Leadley, K. (2010) Outcomes in patients with de novo left main disease treated with either percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the Synergy Between Percutaneous Coronary Intervention with TAXUS. Circulation, 121(24): 2645-53
Ohman, M.E., Nanas, J., Stomel, R.J., Leesar, M.A., Nielsen, D.W.T., Dea, D.O., Rogers, F.J., Harber, D., Hudson, M.P., Fraulo, E., Shaw, L.K., Lee, K.L. (2005) Thrombolysis and counterpulsation to improve survival in myocardial infarction complicated by hypotension and suspected cardiogenic shock or heart failure: results of the TACTICS Trial. J Thromb Thrombolysis, 19(1): 33-9
Pandya, S.B., Kim, Y.H., Meyers, S.N., i dr. (2010) Drug-eluting versus bare-metal stents in unprotected left main coronary artery stenosis a meta-analysis. J Am Coll Cardiol Intv, 3(6): 602
Sarasin, F.P., Junod, A.F., Carballo, D., Slama, S., Unger, P.F., Louis-Simonet, M. (2002) Role of echocardiography in the evaluation of syncope: a prospective study. Heart, 88(4): 363-7
Steg, P.G., James, S.K., Atar, D., Badano, L.P., Blömstrom-Lundqvist, C., Borger, M.A., di Mario, C., Dickstein, K., Ducrocq, G., Fernandez-Aviles, F., Gershlick, A.H. (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J, 33(20): 2569-619
Thiele, H., Zeymer, U., Neumann, F., Ferenc, M., Olbrich, H., Hausleiter, J., Richardt, G., Hennersdorf, M., Empen, K., Fuernau, G., Desch, S., Eitel, I. (2012) Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med, 367(14): 1287-96
Wasek, W., Kułakowski, P., Czepiel, A., Kłosiewicz-Wasek, B., Budaj, A., Soszyńska, M., MacIejewski, P., Stec, S., Ceremuzyński, L. (2000) Susceptibility to neuromediated syncope after acute myocardial infarction. European Journal of Clinical Investigation, 30(5): 383-8