POST PRANDIAL ANGINA WITH DOUBLE VESSEL DISEASE ,TOTAL OCCLUSION OF LEFT ANTERIOR DESCENDING ARTERY

Clinicians often assume that patients with postprandial epigastric or chest discomfort have gastrointestinal disease
Postprandial angina likely to have non-postprandial rest angina , more diagnosed unstable angina and worse left-ventricular function
Likely to have more severe coronary disease, including LM disease and three-vessel disease

1. POST PRANDIAL ANGINA DR.MALLESH.K MD,DNB,DM(CARDIOLOGY) INTERVENTIONAL CARDIOLOGIST AND PEDIATRIC CARDIOLOGIST

2. HISTORY MIDDLE AGE FEMALE DIABETES FOR 6 YEARS POOR CONTROL HYPERTENSON FOR 6 YEARS POOR COMPLIANCE PRESENTED WITH : MIDLINCE MODERATE TO SEVERE CHEST DISCOMFORT FOLLOWING MEALS FOR 4 DAYS SIMULTANEOUSLY EXPERIENCING BACK ACHE CHEST PAIN SUBSIDING TRANSIENTLY WITH ANTI GASTRITIS MEDIINES EXERTIONAL BREATHLESSNESS NYHA CLASS I-II -4 DAYS

3. EXAMINATION PUSLE RATE 86BPM, RESPIRATORY RATE- 18CYCLES/M BLOOD PRESSURE-210/11MM HG SATURATION -96% IN ROOM AIR CVS- LV S3 HEARD. P2 NORMAL,NO MURMUR RS- BILATERAL FEW RHONCHI HEARD CNS –GCS-15/15,NO DEFICITS

4. INVESTIGATIONS POORLY COTROLLED DIABETES DYSLIPIDEMIA CARDIAC TROPONIN IPOSITIVE

5. INVESTIGATIONS NORMAL RENAL FUNCTION TEST HYPER URICEMIA NORMAL SERUM ELECTROLYTES

6. INVESTIGATION SINUS RHYTHM NORMAL AXIS NO E/O LVH ?SUBTLE HUGGING OF ST SEGMENT IN I,V5-6

7. INVESTIGATIONS MILDLY INCREASED TOTAL COUNT NORMAL HEMOGLOBIN NORMAL THYROID FUNCTION OTHER – CT CHEST TO RULE OUT AORTIC DISSECTION - NORMAL

8. CORONARY ANGIOGRAM LEFT ANTERIOR DECENDING ARTERY TOTAL OCCLUDED DEVREASED MYOCARDIAL BLUSH IN THE CORRESPONGING AREA LEFT CIRCUMFLEX 60-70% OCCLUDED

9. PTCA TO LAD WIRE CROSSED ACROSS LAD OCCLUTION

10. DES STENT DEPLOYED

11. POST DES DEPLOYMENT LAD FLOW IS GOOD WITH TIMI 3 FLOW AFTER DES PLACEMENT

12. SUMMARY Eating is a known precipitant of angina attacks. Clinicians often assume that patients with postprandial epigastric or chest discomfort have gastrointestinal disease Postprandial angina likely to have non-postprandial rest angina , more diagnosed unstable angina and worse left-ventricular function Likely to have more severe coronary disease, including LM disease and three-vessel disease Berlinerblau R; Shani J. Postprandial angina pectoris: clinical and angiographic correlations.  J Am Coll Cardiol  1994 Mar 23 627629

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