Rapid Resolution of Coronary Artery Spasm Complicated by Acute Systolic Heart Failure with Antirejection Therapy in Acute Orthotopic Heart Transplant Rejection
نویسندگان
چکیده
We report a case of rapid resolution of Coronary Artery Spasm (CAS) and improvement of systolic heart failure by antirejection therapy with methylprednisolone in the setting of acute Orthotopic Heart Transplant (OHT) rejection. The proposed mechanism of action is reduced microvascular inflammation from steroid therapy resulting in enhanced vasomotor response, resolution of coronary artery spasm, and improved hemodynamic. The case report has treatment implications for patients in acute OHT rejection with coronary artery spasm. Antirejection therapy with steroid may be helpful in treating life threatening cardiac conditions in patients with acute OHT rejection and coronary artery spasm. *Corresponding author: Howard Lan, Loma Linda University Medical Center, 11234 Anderson Street, Suite 2426, Loma Linda, CA 92354, USA, Tel: +1-909-558-7674; Fax: +1-909-651-5938; E-mail: [email protected] Received November 16, 2016; Accepted November 28, 2016; Published December 05, 2016 Citation: Lan H, Stoletniy L, Sakr A, Hilliard A (2016) Rapid Resolution of Coronary Artery Spasm Complicated by Acute Systolic Heart Failure with Antirejection Therapy in Acute Orthotopic Heart Transplant Rejection. Cardiovasc Pharm Open Access 5: 201. doi: 10.4172/2329-6607.1000201 Copyright: © 2016 Lan H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. LVEDP of 14 mmHg. Laboratory studies collected on admission revealed the presence of new human leukocyte antigen HLA-DQ, HLA-DQ7, and anti-complement C1q antibodies indicating that the patient had acute antibody mediated rejection (AMR). Echocardiogram showed a reduction in left ventricular ejection fraction from 75%, one month prior, to 45% with elevated filling pressures. Individualized treatment plan for AMR was escalated to include plasmapheresis [5,8], intravenous immunoglobulin [5,8], and antithymocyte globulin [9,10] infusion. Patient’s clinical status improved with OHT antirejection therapy and was discharged home on hospital day ten.
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