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Coronary Vasospasm in Burn Patients: First Reported Case Series of a Lethal Disease
Derek M. Culnan MD, Jason B. Garlie MD, Kaushang Gandhi MD, Rolf P. Kreutz MD and Rajiv Sood MD
Indiana University Plastic Surgery
2014-03-15
Presenter: Derek M. Culnan
Affidavit:
Director Name: Rajiv Sood
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background
We present a series of three patients developing acute coronary syndrome (ACS) stemming from coronary vasospasm (CVS) over five months. This etiology of ACS is significant because it has not previously been described in burn patients, and it requires a different management than atherosclerotic disease.
Case Series
Patients were admitted to a single accredited burn unit. Burn mechanisms were flash burn, chemical fire and house fire. TBSA was 19.5%, 72% and 20%, respectively. Cases were 67, 41 and 52 year old men. All patients smoked tobacco, which is a CVS risk factor. One had diabetes and stable coronary artery disease with a negative nuclear stress test. CVS presented with dynamic ST elevations, unstable bradycardia and cardiac arrest in all cases. Diagnosis was made by electrocardiogram and coronary angiography. Vasospasm resolved with intracoronary injection of nitroglycerin. Patients were subsequently treated with nitrates and calcium channel blockers. One of the patients died of refractory disease.
Conclusions
Three patients were diagnosed with a potentially lethal ACS conclusively linked to CVS over a period of five months. To date there is no described linkage between CVS and burns in humans. There is a well-described animal model in rats. The risk factors for CVS are common in burn patients particularly smoking and endothelial dysfunction. CVS may be a significant cause of ACS in burn patients and it should be considered in the differential diagnosis, especially those cases with rapid onset and spontaneous resolution of ST elevations, unstable bradycardia or unexplained cardiac arrest.
