post cardiac transplant coronary artery disease

Etiology: - endothelial cell injury either humoral or cell-mediated is thought to be etiology Epidemiology: 1) primary cause of death >1 year after transplant 2) occurs in > 50% of patients 5 years after transplant Pathology: - differs from conventional CAD 1) collateral development around clogged arteries is uncommon, thus infarcts tend to be more extensive 2) resembles PTCA restenosis 3) intimal thickening secondary to smooth muscle proliferation & collagen accumulation Clinical manifestations: 1) angina pectoris does not occur because of lack of innervation 2) heart failure & sudden cardiac death are 2 most common presentations Radiology: - coronary angiography - generally shows diffuse tapering vessels rather than discrete focal stenosis Management: - no effective treatment known

References

Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998