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Coronary Steal Syndrome

Coronary steal syndrome occurs when blood flow to certain sections of the heart is reduced due to alterations in circulation patterns. It is caused when the coronary arteries are narrowed and a vasodilator drug is used, which shunts blood away from ischemic zones of the heart towards more dilated vessels, worsening ischemia. It is associated with drugs like dipyridamole, isoflurane, hydralazine, and nitroprusside, as they can cause excessive vasodilation that steals blood from stenotic coronary arteries. The condition is diagnosed using stress tests, ECGs, or coronary angiography.

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218 views3 pages

Coronary Steal Syndrome

Coronary steal syndrome occurs when blood flow to certain sections of the heart is reduced due to alterations in circulation patterns. It is caused when the coronary arteries are narrowed and a vasodilator drug is used, which shunts blood away from ischemic zones of the heart towards more dilated vessels, worsening ischemia. It is associated with drugs like dipyridamole, isoflurane, hydralazine, and nitroprusside, as they can cause excessive vasodilation that steals blood from stenotic coronary arteries. The condition is diagnosed using stress tests, ECGs, or coronary angiography.

Uploaded by

Edward Xiam
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Coronary steal (with its symptoms termed coronary steal syndrome or cardiac steal syndrome) is
a phenomenon where an alteration of circulation patterns leads to a reduction in the blood flow
directed to the coronary circulation.[1] It is caused when there is narrowing of the coronary
arteries and a coronary vasodilator[2] is used – "stealing" blood away from those parts of the
heart. This happens as a result of the narrowed coronary arteries being always maximally
dilated to compensate for the decreased upstream blood supply. Thus, dilating the resistance
vessels in the coronary circulation causes blood to be shunted away from the coronary vessels
supplying the ischemic zones, creating more ischemia.

It is associated with dipyridamole. Hence, dipyridamole is a pharmacological success


diagnostically, but a therapeutic failure because of the coronary steal phenomenon.[3]
Coronary steal is also the mechanism in most drug-based cardiac stress tests; When a patient is
incapable of doing physical activity they are given a vasodilator that produces a "cardiac steal
syndrome" as a diagnostic procedure. The test result is positive if the patient's symptoms
reappear or if ECG alterations are seen.
It is also associated with the administration of Isoflurane, which is an inhaled anesthetic.
Hydralazine can potentially cause this condition as well, as it is a direct arteriolar vasodilator.
It has been associated with nitroprusside.

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