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Coronary vasospasm refers to when a coronary artery suddenly undergoes either complete or sub-total temporary occlusion. [ 1 ] In 1959, Prinzmetal et al. described a type of chest pain resulting from coronary vasospasm, referring to it as a variant form of classical angina pectoris . [ 2 ]
Complaints of chest pain should be immediately checked for an abnormal electrocardiogram (ECG). ECG changes compatible but not indicative of variant angina include elevations rather than depressions of the ST segment or an elevated ST segment plus a widening of the R wave to create a single, broad QRS complex peak termed the "monophasic curve". [4]
Wellens' syndrome is an electrocardiographic manifestation of critical proximal left anterior descending (LAD) coronary artery stenosis in people with unstable angina. Originally thought of as two separate types, A and B, it is now considered an evolving wave form, initially of biphasic T wave inversions and later becoming symmetrical, often ...
All symptoms normally resolve within three weeks, and may only last days. [1] Permanent deficits are seen in a minority of patients, ranging from under 10% to 20% in various studies. [ 1 ] Less than 5% of patients experience progressive vasoconstriction, which can lead to stroke, progressive cerebral edema , or even death. [ 1 ]
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Vasospasm refers to a condition in which an arterial spasm leads to vasoconstriction. This can lead to tissue ischemia (insufficient blood flow) and tissue death ( necrosis ). Along with physical resistance, vasospasm is a main cause of ischemia.
SCAD symptoms are the result of a restriction in the size of the lumen of the affected coronary artery. A bleed within the wall of the artery ( tunica intima ) originating from the microvessels that perfuse this muscular layer ( vasa vasorum ) leads to a collection of blood, or hematoma , between the layers of the artery wall. [ 1 ]
Symptoms of the acute coronary syndromes are similar. [8] The cardinal symptom of critically decreased blood flow to the heart is chest pain, experienced as tightness, pressure, or burning. [9] Localization is most commonly around or over the chest and may radiate or be located to the arm, shoulder, neck, back, upper abdomen, or jaw. [9]