36. Clinical profile of coronary slow flow phenomena – A cardiac Y syndrome

Abstract

Coronary slow flow phenomenon (CSFP) is characterized by delayed progression of the contrast medium injected through the coronary tree during Coronary Angiogram (CAG). CSFP is usually observed in patient with various spectrum of Coronary Artery Disease including Acute Coronary Syndrome and Chronic Stable Angina (CSA). The exact pathogenesis of CSFP is unknown, but 80% of patients experience recurrent episodes of typical anginal pain which results in impairment of quality of the life. Endothelial Dysfunction, Inflammation and diffuse atherosclerosis are various proposed pathogenesis of CSFP. CSFP causes significant cardiovascular morbidity due to dynamic ECG changes and symptoms worsening necessitating recurrent hospitalization and they tend to undergo repeated investigations like Coronary Angiogram. Aim: To see clinical characteristics like risk factors and others of coronary slow flow phenomena. Methods: A total of 45 patients over a period of 6 months with Non Obstructive coronaries below the age group of 60 years who presented with Ischemic Heart Disease were studied. Coronary Slow Flow was identified using thrombolysis in myocardial infarction (TIMI) frame count (TFC) method introduced by Gibson. TIMI-2 flow grade (i.e. requiring ⩾3 beats to opacify the vessel) or a corrected TIMI frame count >27 frames have been frequently used. The later is based upon images acquired at 30 frames/second and a correction factor of 1.7 for the LAD Risk factors and profiles of all the patients were studied in detail. Those patients who had Coronary Artery ectasia, coronary aneurysm, ventricular dysfunction, valvular heart disease and connective tissue disorders. were excluded. Results: Out of 45 patients presented with CSFP 95% were males and 5% females with a mean age of 47 years. CSA with Positive Stress Test were 65%, 15% had Unstable Angina and 25% presented with Myocardial Infarction with Positive Troponin I test . Dynamic ECG changes were present in 30% of the cases. Analysing the risk factors, most of the patients had uncontrolled hypertension (75%) and also were smokers (65%). Diabetes was prevalent in 60% of cases and dyslipidemia in 35% of cases. There were no mortalities noted in hospitalized patients. Conclusion: CSFP was prevalent in wide spectrum if Ischemic Heart Disease presenting as CSA and Acute Coronary Syndrome. Most of the patients presented with CSFP were smokers and had uncontrolled Hypertension.