HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Engelman, R. M. Articles by Chircop, R. V. Search for Related Content PubMed PubMed Citation Articles by Engelman, R. M. Articles by Chircop, R. V.

The Annals of Thoracic Surgery, Vol 37, 469-472, Copyright © 1984 by The Society of Thoracic Surgeons

ARTICLES

Rebound vasospasm after coronary revascularization in association with calcium antagonist withdrawal

RM Engelman, I Hadji-Rousou, RH Breyer, P Whittredge, W Harbison and RV Chircop

Four patients experienced life-threatening coronary vasospasm following discontinuation of calcium channel blocking medication at the time of coronary revascularization. The last dose of the calcium blocker in each instance was administered between 8 and 18 hours before operation. Two of the patients were receiving diltiazem (60 mg four times a day) and 2, nifedipine (20 mg four times a day). During this same period, 16 patients had received diltiazem (12.5% incidence of vasospasm) and more than 100 patients, nifedipine (less than 2% incidence). In 3 of the 4 patients, coronary spasm was identified by electrocardiogram and documented as the cause of ischemia in the distribution of a nondiseased right coronary artery. In the fourth patient, spasm had occurred in the distribution of a bypassed left anterior descending coronary artery. In 2 patients in whom the problem was recognized retrospectively, an infarct developed; 1 patient died. In the 2 patients in whom the problem was apparent prior to infarction, nitroglycerin (1 to 3 micrograms/kg/min, intravenously) and nifedipine (10 mg, sublingually every 4 to 6 hours) successfully reversed the ischemic process. The routine administration of calcium at the completion of coronary revascularization may be ill-advised in patients in whom calcium channel blockers have been utilized. Postoperative therapy of this condition with intravenous administration of nitroglycerin and sublingual administration of nifedipine seems to be effective when instituted early.

This article has been cited by other articles:

				J. H. Levy, K. A. Tanaka, and J. M. Bailey Cardiac Surgical Pharmacology Card. Surg. Adult, January 1, 2008; 3(2008): 77 - 110. [Full Text]

				J. M. Bailey, K. A. Tanaka, and J. H. Levy Cardiac Surgical Pharmacology Card. Surg. Adult, January 1, 2003; 2(2003): 85 - 118. [Full Text]

				D. A. Zvara Treatment of Perioperative Myocardial Ischemia Seminars in Cardiothoracic and Vascular Anesthesia, July 1, 2001; 5(2): 166 - 183. [Abstract] [PDF]

				H. Shimokawa, K. Morishige, K. Miyata, T. Kandabashi, Y. Eto, I. Ikegaki, T. Asano, K. Kaibuchi, and A. Takeshita Long-term inhibition of Rho-kinase induces a regression of arteriosclerotic coronary lesions in a porcine model in vivo Cardiovasc Res, July 1, 2001; 51(1): 169 - 177. [Abstract] [Full Text] [PDF]

				K. Morishige, H. Shimokawa, Y. Eto, T. Kandabashi, K. Miyata, Y. Matsumoto, M. Hoshijima, K. Kaibuchi, and A. Takeshita Adenovirus-Mediated Transfer of Dominant-Negative Rho-Kinase Induces a Regression of Coronary Arteriosclerosis in Pigs In Vivo Arterioscler. Thromb. Vasc. Biol., April 1, 2001; 21(4): 548 - 554. [Abstract] [Full Text] [PDF]

				M. Nordlander, M. Pfaffendorf, and H. B. van Wezel Calcium Antagonists for Perioperative Blood Pressure Control Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 1998; 2(3): 231 - 242. [Abstract] [PDF]