Tag: coronary spasm

Coronary Spasm During Thrombolysis

Arteriographic Demonstration of Coronary Spasm During Thrombolysis

By Amin H. Karim MD

In 1986 I was a Cardiology fellow at Baylor College of Medicine. Our cath attending at the V.A. Houston Hospital was a Frenchman Dr. Jacques Heibig, a young cardiologist with his own approach to Cardiology training. We would do 6-7 cases in a single cath lab room. Time was of the essence. He would make us do a quick job and expected us to finish the case in 10 minutes. There was no angioplasty at the time at the V.A. We would do thrombolysis for acute MI using TPA (or blinded to TPA versus Streptokinase when the patient was assigned to TIMI 1 protocol). The TIMI 1 patients would be taken to cath lab within 90 minutes as part of he TIMI protocol to assess if the culprit artery was open and reperfusion established. In the process, we discovered that some patients would have spasm in the partially re-perfused artery prompting me to write up a case report. Two years later we would publish another more formal case report with Dr. Raizner and Dr. Chahine.
Dr. Heibig later moved away from Houston.

coronaryspasmthrombolysis1988Download

Texas Heart Institute Journal 1988: 15; 52-54

Dynamic Coronary Thrombosis

Dynamic Coronary Thrombosis: A possible cause of Prinzmetal’s Variant Angina.

By Amin H. Karim MD
Dr. Albert E. Raizner was the Director of Cardiac Cath Lab at the Houston Methodist Hospital while it was still affiliated with Baylor College of Medicine and even after it dissociated from Baylor. He was my teacher when I did my Cardiology General and Interventional Fellowship at Baylor College of Medicine, Houston, Texas. He and I were very interested in coronary spasm in the days when thrombolysis was the primary treatment of acute coronary syndromes; it would be followed by “rescue” angioplasty if the ST segments remained elevated or there was post infarction angina or residual ischemia. We would come across cases where there was spasm in the coronary artery even without the diagnostic catheter tickling the intima. This lead us to surmise that maybe the presence of thrombus in the artery itself caused the spasm. The paper, we co-authored by another researcher of coronary spasm Dr. Robert A. Chahine, University of Miami School of Medicine, Florida, was published in the Journal of Interventional Cardiology, Vol 3, No. 1, 1990.
Dr. Raizner is now semi retired.

dynamiccorthrombo1990Download