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Akutes Koronarsyndrom durch Diclofenac induzierte Koronarspasmen

Acute coronary syndrome after application of diclofenac

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Summary

We report about a 67-year old man, who was submitted to our clinic with acute coronary syndrome. The cardiac catheterization showed a proximal thrombus in the left anterior descending (LAD). The other coronary arteries did not have significant lesions. After percutaneous transluminal coronary angioplasty with stent-implantation into the proximal LAD the patient remained clinically stable. Cardiac enzymes confirmed no myocardial necrosis. Three days after the acute coronary syndrome the patient developed a podagra, which was treated with colchicinum, diclofenac and local cooling. Five hours after initial therapy the patient developed severe symptoms of angina pectoris and electrocardiographical signs of an acute posterior and anterior myocardial infarction. Immediate coronary angiography demonstrated extended vasospasm of the right coronary artery. Intracoronary application of verapamil and nitroglycerin resolved the coronary spasm. The patient reported about a self-indicated application of diclophenac six hours before hospital admission. This case demonstrates that oral application of diclofenac can provoke coronary vasospasm.

Zusammenfassung

Wir berichten über einen 67-jährigen Patienten, der mit dem Bild eines akuten Vorderwandmyokardinfarktes im Rahmen eines akuten Koronarsyndroms in die Klinik eingeliefert wurde. Die sofort durchgeführte Herzkatheteruntersuchung zeigte einen frischen Thrombus im proximalen Ramus interventrikularis anterior (RIVA) bei sonst unauffälligen Koronararterien. Nach PTCA mit Stent-Implantation in den proximalen RIVA war der Patient vollkommen beschwerdefrei. Die CK, CKMB sowie das Troponin T blieben im Normbereich. Im Verlauf entwickelte der Patient eine Podagra des rechten Großzehengrundgelenkes, welches mit Colchicin, Diclofenac und lokaler Kühlung behandelt wurde. Fünf Stunden nach Gabe von Colchicin sowie Diclofenac klagte der Patient über heftige Angina pectoris-Symptomatik mit elektrokardiographischen Zeichen eines akuten Hinterwand- und Vorderwandmyokardinfarktes. Eine erneute durchgeführte Herzkatheteruntersuchung zeigte ausgeprägte Vasospasmen der rechten Koronararterie. Nach intrakoronarer Verapamil- und Nitroglycerin-Gabe waren die Koronarspasmen deutlich rückläufig und der Patient war beschwerdefrei. Anamnestisch berichtete der Patient, dass er am Abend ca. 6 h vor dem akuten Koronarsyndrom ebenfalls Diclofenac eingenommen hätte. Bei zweimaliger in unmittelbarem Zusammenhang mit der Diclofenac-Einnahme stehenden akuten Koronarsymptomatik ist von einem Diclofenac induziertem Vasospasmus auszugehen.

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Authors and Affiliations

  1. Universitätsklinikum Schleswig Holstein, Campus Kiel, Med. Klinik, Klinik für Kardiologie, Schittenhelmstraße 12, 24105, Kiel, Germany

    A. Wieckhorst,  A. Tiroke,  M. Lins,  A. Reinecke,  G. Herrmann,  D. Krüger &  R. Simon

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  1. A. Wieckhorst
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  2. A. Tiroke
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  3. M. Lins
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  4. A. Reinecke
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  5. G. Herrmann
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  6. D. Krüger
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  7. R. Simon
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Correspondence to A. Wieckhorst.

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Wieckhorst, A., Tiroke, A., Lins, M. et al. Akutes Koronarsyndrom durch Diclofenac induzierte Koronarspasmen. ZS Kardiologie 94, 274–279 (2005). https://doi.org/10.1007/s00392-005-0211-8

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  • DOI: https://doi.org/10.1007/s00392-005-0211-8

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