Author + information
- Nissi Sharon Suppogu,
- Haider Aldiwani,
- Odayme Quesada,
- Janet Wei,
- Chrisandra Shufelt,
- Bruce Samuels and
- C. Noel Bairey Merz
Recognizing and treating women with signs and symptoms of ischemia and non-obstructive coronary artery disease (INOCA) with coronary microvascular dysfunction (CMD) is a challenge for physicians.
An 83-year-old female with history of hypertension, hyperlipidemia presented with exertional angina. Fifteen years prior she had an abnormal stress echo cardiogram with subsequent open arteries on coronary angiogram. We referred her for an adenosine stress cardiac MRI that showed subendocardial hypoperfusion (image A - D) and invasive coronary reactivity test confirmed CMD. She was started on optimal medical therapy which improved angina and exercise capacity. Recently she was admitted at an outside hospital for abdominal surgery and her cardiac medications were held. Postoperative day 1, she developed chest pain, ischemic ECG changes (image E), and peak troponin of 0.21 ng/mL. Regadenoson SPECT showed a reversible anterior defect (image F), however the treating physician explained that this was artifact and did not restart her cardiac medications
Anti-ischemic cardiac medications should be continued in women with CMD prior to surgery unless contra-indicated. Abnormal stress perfusion in the setting of CMD with INOCA is not artifact. The patient met criteria for acute myocardial infarction supporting starting cardiac medications as per guidelines.
This case stresses the importance of physician education to recognize and treat women with INOCA with CMD.
Poster Hall, Hall F
Monday, March 18, 2019, 9:45 a.m.-10:30 a.m.
Session Title: FIT Clinical Decision Making: Acute and Stable Ischemic Heart Disease 3
Abstract Category: Acute and Stable Ischemic Heart Disease
Presentation Number: 1310-097
- 2019 American College of Cardiology Foundation