Objective
Coronary slow flow is characterized by the delayed opacification of coronary arteries in the absence of obstructive coronary artery disease on coronary angiography. Coronary slow flow is thought to be a reflection of a systemic slow-flow phenomenon in the coronary arterial tree. Glucocorticoids cause an increase in coronary artery constriction and hence decrease coronary artery blood flow and this entity might be valid for all systemic arterial network.
CASE
A forty-four years old man presented with chest pain causing fatigue together with blurred vision for the last two years which disappears after resting. He had erectile dysfunction, hypertension and hyperlipidemia. He used corticosteroid one month ago for facial paralysis. His vision, ocular pressure, biomicroscopic examination and retina were also normal. There was no abnormality in electrocardiogram and echocardiography. Neurological examination and cranial computerized tomography imaging analyzed for the differential diagnosis of multiple sclerosis was normal. On the basis that he had typical symptoms and a strong family history, he underwent coronary angiography. Coronary slow flow was detected in all three major coronary arteries without any obstructive disease. TIMI measurements for left anterior desending artery (Figure 1), circumflex and right coronary artery were 64 (corrected: 37.6), 72, and 55 respectively. Later on, the patient underwent detailed ophthalmologic evaluation to clarify visual symptıms. In fundus flourescein angiography, retina was normal, the arm to retina circulation time was 21.8 seconds, and the arteriovenous transit time was 4.3 seconds. In the early arteriovenous phase, choroidal filling was long with physiological patchy type. Indocyanine green angiography showed Watershed styled vascular filling. Choroid was not still fully filled after 30 seconds. Diltiazem 90mg/day and asetilsalisylic acid 100 mg/day was given for coronary slow flow. His chest pain and visual symptoms had disappeared with the medication. After treatment in fundus flourescein angiography, the arm to retina circulation time was 15.8 seconds.
CASE
A forty-four years old man presented with chest pain causing fatigue together with blurred vision for the last two years which disappears after resting. He had erectile dysfunction, hypertension and hyperlipidemia. He used corticosteroid one month ago for facial paralysis. His vision, ocular pressure, biomicroscopic examination and retina were also normal. There was no abnormality in electrocardiogram and echocardiography. Neurological examination and cranial computerized tomography imaging analyzed for the differential diagnosis of multiple sclerosis was normal. On the basis that he had typical symptoms and a strong family history, he underwent coronary angiography. Coronary slow flow was detected in all three major coronary arteries without any obstructive disease. TIMI measurements for left anterior desending artery (Figure 1), circumflex and right coronary artery were 64 (corrected: 37.6), 72, and 55 respectively. Later on, the patient underwent detailed ophthalmologic evaluation to clarify visual symptıms. In fundus flourescein angiography, retina was normal, the arm to retina circulation time was 21.8 seconds, and the arteriovenous transit time was 4.3 seconds. In the early arteriovenous phase, choroidal filling was long with physiological patchy type. Indocyanine green angiography showed Watershed styled vascular filling. Choroid was not still fully filled after 30 seconds. Diltiazem 90mg/day and asetilsalisylic acid 100 mg/day was given for coronary slow flow. His chest pain and visual symptoms had disappeared with the medication. After treatment in fundus flourescein angiography, the arm to retina circulation time was 15.8 seconds.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
