[Sudden syncope and myocardial ischemia. Apropos of a case]. / Syncope à l'emporte-pièce et ischémie myocardique. A propos d'une observation.

It is unusual to carry out a systematic search for myocardial ischemia in patients who have suffered a sudden syncopy with no known history of angina. We report a case involving loss of consciousness (LC) in the context of sub-hissian atrioventricular block (AVB) which required the installation of a pacemaker, with the detection of angina pectoris immediately after its installation. Coronary artery angiography confirmed a diagnosis of severe, multitrunk coronary disease characterized by a tight stenosis of the common trunk. If consciousness is lost by a patient suffering from baseline conduction impairment with no chest pain, the first thought is 3rd degree degenerative paroxysmal AVB but the possibility of an ischemic origin of this AVB should not be overlooked.

[Transmural myocardial infarction and Prinzmetal's syndrome in an allergic reaction to glafenine. Physiopathological discussion. Apropos of a case]. / Infarctus myocardique transmural et syndrome de Prinzmetal au cours d'une réaction allergique à la glafénine. Discussion physiopathologique. A propos d'un cas.

The authors report the case of a 38 year old man who experienced at two month' interval, hypersensitivity reactions to the ingestion of 200 mg tablets of glafenine, complicated on the first occasion by a transmural anterior wall myocardial infarction as the first manifestation of coronary artery disease and on the second occasion by Prinzmetal angina due to posterior wall ischaemia. Coronary angiography was more or less normal. The timing of the symptoms in the context of an anaphylactic reaction and their repetition when the same molecule was reintroduced are strong arguments in favour of the pathogenic role of glafenine, even in the absence of biological criteria which are always variable. The mechanism of the coronary problems is discussed with reference to mediators released during the anaphylactic reaction: coronary vasoconstriction due to histamine and leukotriene release; inhibition of prostaglandin synthesis causing potentiation of the effects of histamine; lowering of the vasodilatory and antiaggregant prostacyclin enhancing the vasoconstrictor and platelet aggregant action of thromboxane A2. All the conditions favouring the initiation of coronary spasm with eventual coronary thrombosis, the one aggravating the other, are therefore present.