Definition

  Delayed opacification of distal coronary vasculature

      in patients with normal or near-normal epicardial coronary arteries.

  Delayed opacification is present if at least
3 or more cardiac cycles

      are needed to opacify the coronary distal vasculature.




Clinical findings

  Most patients present with rest angina.

  Some patients may present as acute coronary syndrome.

  Most commonly affects male smokers.

  ECG abnormalities suggestive of ischemia may be seen.

  Coronary slow flow has been observed in 1-7% of subjects undergoing coronary angiography.




Pathogenesis

  The pathogenesis has not been fully elucidated.

  ECG signs of ischemia are frequent but there is no pathognomonic ECG sign.

 
Increased resting peripheral (coronary) resistances caused by structural microvascular abnormalities

      have been suggested.

  In contrast to coronary syndrome X,
coronary flow reserve in response to vasodilators

      appears to be intact
in these "syndrome Y" patients.



Abnormal ECG findings in patients with coronary slow flow phenomenon

  ST segment elevation (pain-free).

  ST segment depression (pain-free).

  T wave inversion.

  Peaked T waves.

  Higher prevalance of positive (abnormal) exercise test.




References

  Int J Cardiol 2006;112:e1-e4.

  Angiology 2001;52:507-514.

  Int J Cardiol 2011;146:457-458.

  Int J Cardiol 2012;156:84-91.

  Int J Cardiol 2008;127:358-361.

  Cardiology 2002;97:197-202.

  Int J Cardiol 2009;137:308-310.

  Korean Circ J 2013;43:196-198.

  Journal of Electrocardiology 2012;45:277-279.





ECG 1. The ECG above belongs to a 68 years-old woman with coronary slow flow phenomenon.
Widespread T wave negativity imitates ECG signs of myocardial ischemia.

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ECG 2. The ECG above belongs to a 45 years-old man with coronary slow flow phenomenon.
There are q waves in leads V1 to V3. However the patient did not have previous myocardial infarction.

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ECG 3. The ECG above belongs to a 53 years-old man with coronary slow flow phenomenon.
Negative T waves in leads V1-V2, and non-specific T wave changes are seen in leads V3-V4.

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ECG 4. The ECG above belongs to a 64 years-old woman with coronary slow flow phenomenon.
Chest leads show asymmetrically negative T waves and biphasic T waves with terminal negativity.

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ECG 5. The ECG above belongs to a 56 years-old woman with coronary slow flow phenomenon.
Non-specific T wave changes are seen in chest leads.

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ECG 6. The ECG above belongs to a 58 years-old man with coronary slow flow phenomenon.
Chest leads show peaked T waves.

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ECG 7. The ECG above belongs to a 75 years-old man with coronary slow flow phenomenon.
Non-specific T wave changes are seen in leads V4-V5.

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ECG 8. The ECG above belongs to a 76 years-old hypertensive man with coronary slow flow phenomenon.
Left bundle branch block, first degree AV block and Chapman's sign are seen.

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ECG 9. The ECG above belongs to a 67 years-old man with coronary slow flow phenomenon.
Leads II and aVF show minimal ST segment elevation.
Leads V2 to V5 show relatively tall T waves when compared to the preceding QRS complexes.

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ECG 10. The ECG above belongs to a 44 years-old man with coronary slow flow phenomenon.
Leads V4 to V6 show biphasic T waves: not typical for myocardial ischemia or strain pattern.

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