Skip to main content
PMC home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2007 Oct 23;31(8):352–355. doi: 10.1002/clc.20266

Coronary Slow Flow Phenomenon and Risk for Sudden Cardiac Death Due to Ventricular Arrhythmias: A Case Report and Review of Literature

Shoaib Saya 1,✉, Thomas A Hennebry 1, Pedro Lozano 1, Ralph Lazzara 1, Eliot Schechter 1
PMCID: PMC6653277  PMID: 17957738

Abstract

We report a case of coronary slow flow phenomenon (CSFP) in a patient who underwent coronary angiography due to anginal chest pain and recurrent syncope with complete normalization of flow after intracoronary adenosine. He was noted to have multiple episodes of nonsustained ventricular tachycardia on holter monitor and increased QTc dispersion on surface electrocardiogram (EKG). He responded very well to oral dipyridamole therapy with complete resolution of his symptoms and no episodes of ventricular tachycardia on the event recorder at 3 months. We review the diagnosis and clinical features of CSFP and its association with increased QTc dispersion and the role of oral dipyridamole therapy in this condition. Copyright © 2007 Wiley Periodicals, Inc.

Keywords: arrhythmia; syncope; cardiac catheterization; diagnostic interventional; electrocardiography, ambulatory ECG; endothelial function dysfunction

Full Text

The Full Text of this article is available as a PDF (2.3 MB).

References

  • 1. Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E: Angina pectoris and slow flow velocity of dye in coronary arteries‐ a new angiographic finding. Am Heart J 1972; 84: 66–71. [DOI] [PubMed] [Google Scholar]
  • 2. Beltrame JF, Limaye SB, Horowitz JD: The coronary slow flow phenomenon ‐ a new coronary microvascular disorder. Cardiology 2002; 97: 197–202. [DOI] [PubMed] [Google Scholar]
  • 3. Singh S, Kothari SS, Bahl VK: Coronary slow flow phenomenon: an angiographic curiosity. Indian Heart J 2004; 56(6): 613–617. [PubMed] [Google Scholar]
  • 4. Diver DJ, Bier JD, Ferreira PE, Sharaf BL, McCabe C, et al.: Clinical and arteriographic characterization of patients with unstable angina without critical coronary arterial narrowing (from the TIMI‐IIIA Trial). Am J Cardiol 1994; 74: 531–537. [DOI] [PubMed] [Google Scholar]
  • 5. Gibson CM, Cannon CP, Daley WL, Dodge JT, Alexander B, et al.: TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996; 93: 879–888. [DOI] [PubMed] [Google Scholar]
  • 6. Goel PK, Gupta SK, Agarwal A, Kapoor A: Slow coronary flow: a distinct angiographic subgroup in syndrome X. Angiology 2001; 52: 507–514. [DOI] [PubMed] [Google Scholar]
  • 7. Demirkol MO, Yaymaci B, Mutlu B: Dipyridamole myocardial perfusion single photon emission computed tomography in patients with slow coronary flow. Coron Artery Dis 2002; 223–229. [DOI] [PubMed] [Google Scholar]
  • 8. Cesar LA, Ramires JA, Serrano Junior CV, Meneghetti JC, Antonelli RH, et al.: Slow coronary runoff in patients with angina pectoris clinical significance and thallium‐201 scintigraphic study. Braz J Med Biol Res 1996; 29(5): 605–613. [PubMed] [Google Scholar]
  • 9. Beltrame JF, Limaye SB, Wuttke RD, Horowitz JD: Coronary hemodynamic and metabolic studies of the coronary slow flow phenomenon. Am Heart J 2003; 146: 84–90. [DOI] [PubMed] [Google Scholar]
  • 10. Kapoor A, Goel PK, Gupta S: Slow coronary flow–a cause for angina with ST segment elevation and normal coronary arteries: a case report. Int J Cardiol 1998; 67: 257–261. [DOI] [PubMed] [Google Scholar]
  • 11. Mangieeri E, Macchiarelli G, Ciavolella M, Barilla F, Avella A, et al.: Slow coronary flow: clinical and histopthological features in patients with otherwise normal epicardial coronary arteries. Cathet Cardiovasc Diagn 1996; 37: 375–381. [DOI] [PubMed] [Google Scholar]
  • 12. Mosseri M, Yarom R, Gotsman MS, Hasin Y: Histologic evidence for small vessel coronary disease in patients with angina pectoris and patent large coronary arteries. Circulation 1986; 74: 964–972. [DOI] [PubMed] [Google Scholar]
  • 13. Sezgin AT, Sigircl A, Barutcu I, Topol E, Sezgin N, et al.: Vascular endothelial function inpatients with slow coronary flow. Coron Artery Dis 2003; 14: 155–161. [DOI] [PubMed] [Google Scholar]
  • 14. Newby AC: How does Dipyridamole elevate extraceluular adenosine concentration? Biochem J 1986; 845–851. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15. Fam WM, Mcgregor M: Effect of nitroglycerin and dipyridamole on regional coronary microvascular resistance. Circ Res 1968; 22: 649–659. [DOI] [PubMed] [Google Scholar]
  • 16. Kurtoglu N, Akcay A, Dindar I: Usefulness of oral dipyridamole therapy for angiographic slow coronary artery flow. Am J Cardiol 2001; 87: 777–779. [DOI] [PubMed] [Google Scholar]
  • 17. De Bruyne MC, Hoes AW, Kors JA: QTc dispersion predicts cardiac mortality in the elderly: the Rotterdam Study. Circulation 1998; 97: 467–472. [DOI] [PubMed] [Google Scholar]
  • 18. Zareba W, Moss AJ, Le Cessie S: Dispersion of ventricular repolarizationand arrhythmic cardiac death in coronary artery disease. Am J Cardiol 1994; 74: 550–553. [DOI] [PubMed] [Google Scholar]
  • 19. Ramazan A, Turhan H, Sezgin AT, Yetkin O, Senen K, et al.: Effect of slow coronary artery flow on QT Interval duration and dispersion. Ann Noninvasive Electrocardiol 2003; 8(2): 107–111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20. Aksakal E, Yapici O, Yazici M, Yilmaz O, Sahin M: Int J Cardiovasc Imaging 2005; 21(2–3): 185–188. [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES