Book review
https://doi.org/10.3325/cmj.2021.62.28 3
Atrial fibrillation as a contributing factor in the diagnostic algorithm for coronary subclavian steal syndrome and cardiac tamponade following coronary artery bypass graft surgery: a case study
Luka Perčin
; Department of Cardiovascular Diseases, University Hospital Center Zagreb, Zagreb, Croatia
Blanka Glavaš Konja
; Zagreb University School of Medicine, Zagreb, Croatia
Joško Bulum
; Department of Cardiovascular Diseases, University Hospital Center Zagreb, Zagreb, Croatia
Dražen Perkov
; Department of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, Zagreb, Croatia
Majda Vrkić Kirhmajer
; Zagreb University School of Medicine, Zagreb, Croatia
Abstract
Coronary subclavian steal syndrome (CSSS) is a complica
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tion of coronary artery bypass graft (CABG) surgery in pa
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tients with coexistent significant subclavian artery stenosis
(SAS). It is characterized by a retrograde blood flow through
the left internal mammary artery graft from the coronary
to subclavian circulation, leading to myocardial ischemia.
Current screening for CSSS includes bilateral blood pres
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sure measurement for the detection of a significant interarm blood pressure difference. However, the commonly
used automated sphygmomanometers have limited accu
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racy in patients with atrial fibrillation. Consequently, these
patients are often underdiagnosed. We present a case of a
73-year-old man with a medical history of atrial fibrillation,
peripheral artery disease, and CABG surgery four months
before the current event, who came to the emergency de
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partment due to progressive dyspnea. The initial diagnos
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tic management showed a large circulatory pericardial effusion, so the patient was admitted to the coronary care
unit and underwent pericardial drainage. In the following
days, due to a sudden high increase in cardiac troponin,
the patient underwent an urgent coronary angiography,
which revealed severe left SAS with functional CABG, indi
-
cating the occurrence of CSSS. Percutaneous transluminal
angioplasty was then performed with an optimal angio
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graphic result. The patient was discharged in good condi
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tion with adequate medicament therapy and instructions.
This case report highlights atrial fibrillation as a contribut
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ing factor for the diagnosis of CSSS and pericardial tam
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ponade after CABG surgery. Furthermore, we suggest a di
-
agnostic approach that can reduce the incidence of both
these severe complications
Keywords
Hrčak ID:
278141
URI
Publication date:
24.6.2021.
Visits: 425 *