Coronary Subclavian Steal Syndrome: An Unusual Cause of Angi
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Coronary subclavian steal syndrome is a rare but well-recognized complication of coronary artery bypass grafting surgery when a left internal mammary artery graft is used. This syndrome is characterized by retrograde blood flow from the LIMA to the distal subclavian artery to perfuse the upper extremity when a severe proximal SA stenosis is present. As a result, a coronary steal phenomenon may develop whereby the myocardium perfused by the LIMA graft can become ischemic despite the patency of the grafted vessels.

We describe the case of an 84-year-old male with history of diabetes mellitus, hypertension, atherosclerotic carotid disease, and three-vessel coronary artery disease (CAD) with CABG 6 years ago, who presented with moderate intensity 5 out of 10 prolonged left-sided chest pain, worse with physical activity involving the left upper extremity. The pain persisted overnight and the patient presented the following day to the emergency department. Since bypass surgery, the patient had been doing well with no anginal symptoms and was maintained on aspirin 81?mg daily, clopidogrel 75?mg daily, metoprolol 25?mg twice daily, enalapril 10?mg daily, and metformin 500?mg twice daily. He received an LIMA graft to the left anterior descending artery (LAD) and saphenous vein grafts to the posterior descending and marginal arteries with his CABG surgery.....