Chronic silent coronary syndrome – diagnostic features

Abstract

Introduction. Chronic coronary syndrome (CCS) is a range of clinical manifestations or syndromes Resulting from structural and/or functional changes in the coronary arteries and/or microvascular system, often Resulting in hypoperfusion. It may be symptomatic (angina, chest discomfort, dyspnea) or asymptomatic. Objective(s). Presentation of the clinical case of an elderly patient with nonspecific manifestation of CCS. The patient was known to have uncontrolled HTN for 5 years and no other cardiovascular risk factors. Materials and methods. A 69-year-old man of normal weight, presenting with fatigue, visits the cardiologist. No history of angina pectoris, but with sequelae in the LV antero-septal region on the ECG. Investigations were performed: cardiac biomarkers (Troponin, CK-MB), repeated ECG, ECHOCG. At the next visit was recommended to perform Coronary Angiography. Results. Cardiac biomarkers: TnI – 0.01 ng/ml, CK-MB – 14 U/L. ECG: Sinus rhythm, HR – 56 bpm, QRS axis deviated to the left, complete LAFB, sequelae in the anteroseptal wall of the LV. ECHO: Mild LA dilation, normal LV dimensions, IVS and LVPW – 8-9 mm, preserved EF – 50%, LV apex akinesia (thickness in the given region ~ 4.0-4.5 mm), impaired relaxation of the LV. Coronary angiography: Tricoronary atherosclerotic lesions: severe stenoses on RCA and aCX (OM II), moderate on LAD (DIA I). Coronary angioplasty with pharmacologically active stent implantation on the RCA III was performed, with restoration of the arterial lumen – «blush» grade 3. Conclusion(s). Thorough screening of people at risk for ischemic cardiopathy by evaluating the ECG, cardiac biomarkers, and ECHOCG, will contribute to the prompt detection of patients with silent coronary ischemia, indication of the correct treatment and prevention of acute cardiovascular events.