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A retrospective analysis of the clinical course, management and outcomes of patients with ASC.
ASC has been frequently seen in patients who presented with acute coronary syndrome (ACS).
55 patients (Females (93%), Caucasians (91%), Postmenopausal (78%) and Australian-born (64%), met the modified mayo diagnostic criteria for ASC admitted to the Gold coast hospital between Jan 2007 to Jun 2012.
Emotional stress a significant precipitating event (55%). Common symptoms: chest pain (87%) and dyspnea (44%). Out of hospital VF cardiac arrest (04%). ECG abnormalities: T wave inversion (67%), ST segment elevation (33%) and QTc prolongation (47%). Elevated TnI > x5 times (91%). Management of ST segment elevation type: fibrinolysis (04%) and primary PCI activation (20%). Angiographic LAD abnormalities: CAD ∼≥50% (07%), coronary vasospasm (04%), distal wrap around (02%). LV evaluation: classic variant (95%) and mid-ventricular variant (05%). Average LVEF was 50% (range 18 – 70%) during contractile abnormality which improved to 66% (range 45 – 78%) during recovery. In-hospital complications (33%): acute pulmonary oedema (18%), cardiogenic shock (09%), paroxysmal AF (07%), LV apical thrombus (07%) & SEC (02%), transient dynamic LV outflow tract obstruction (05%), severe mitral regurgitation (02%), VF cardiac arrest (02%) and death (02%). During the follow-up, majority had good recovery with insignificant complications, recurrence (02%) and deaths (04%).
ASC is a reversible condition, most commonly seen in postmenopausal women. 1/3 had significant in-hospital complications. However, majority had a good prognostic with an insignificant number of recurrence and deaths.