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(Circulation. 2000;101:e198.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Oculostenotic Reflex and Iatrogenosis Fulminans

Ozlem Soran, MD; Arthur M. Feldman, MD, PhD; Howard A. Cohen, MD

From the Cardiovascular Institute of the UPMC Health System, Pittsburgh, Pa.

Correspondence to Arthur M. Feldman, MD, PhD, Director, The Cardiovascular Institute of the UPMC Health System, 200 Lothrop St, S-572 Scaife Hall, Pittsburgh, PA 15213.

	Introduction

 
A 68-year-old man with no active cardiac symptoms was seen in our outpatient center for a second opinion after having undergone 4 percutaneous revascularization procedures in the previous 5 months at an outside hospital. Five years before this visit, the patient had undergone a routine treadmill exercise test that showed changes suggestive of coronary artery disease. Although he was asymptomatic and active, a cardiac catheterization was performed, which demonstrated "50% to 60%" obstructions. He was treated with a low-fat diet, simvastatin, amlodipine, and atenolol. He did not receive antiplatelet therapy.

Four months before the second opinion, the patient had undergone a second thallium stress test for follow-up. The study was suggestive of mild inferoposterior ischemia, and the patient again underwent diagnostic coronary angiography. The arteriogram was reported to be notable for hemodynamically significant lesions in the proximal left anterior descending coronary artery (LAD) (Figure, A), in the circumflex coronary artery (LCx) (B), and in the origin of a posterolateral branch of the right coronary artery (C). At the time of the diagnostic coronary angiography, balloon angioplasty was performed on the LAD stenosis (D). Approximately 1 week later, angioplasty was performed on the LCx and posterolateral coronary arteries, with a stent being placed in the LCx.

View larger version (150K): [in this window] [in a new window]   Figure 1.

Two months after the second procedure, the patient became symptomatic for the first time and was hospitalized because of substernal chest pain occurring with minimal exertion. After stabilization with intravenous heparin, aspirin, and nitrates, a coronary angiogram was obtained that demonstrated a high-grade stenosis . . . [Full Text of this Article]

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