Objective: Describe a patient with PD who suffered an acute myocardial infarction during a severe OFF period.

Background: Advanced PD is characterized by complications including dyskinesias and motor and non-motor (NM) fluctuations, related to chronic L-dopa use.  OFF phenomenon in PD involves a variation of symptoms throughout the day, characterized by a reappearance of symptoms after a period of good functioning. NM fluctuations have a high impact on quality of life even more than motor symptoms.

Method: We describe a 58-year-old Colombian woman, without cardiovascular risk factors that at 31 years old she started rigid bradykinetic syndrome. After 6 years of illness, wearing-off NM-symptoms began; after 10 years ON dyskinesias appeared, and after 20 years unpredictable OFF episodes, with tremor, freezing, toe dystonia, anxiety, distress, palpitations and tachycardia.  During a severe OFF episode, she presented high-intensity oppressive chest pain radiating to left arm. She went to Emergency Room, where ECG showed an inferobasal ischemia and positive troponin. Causes other than dysautonomia were ruled out, and she was admitted in Acute Heart Unit, where a coronary dissection of distal anterior descending artery was demonstrated. After adding opicapone and rescue subcutaneous apomorphine, a significant control of OFF symptoms was achieved. She was considered for functional surgery (DBS-NST), but patient postponed the decision.

Results: Autonomic fluctuations are reported in 16-90% of patients with PD. (3) Some autonomic symptoms improve in parallel with motor symptoms after administration of dopaminergic drugs; however, they are not necessarily synchronous with motor symptoms, and therefore, they do not always respond to L-dopa. (4) Literature describes case reports of some dysautonomic symptoms that can “mimic” emergencies (3), but none with life-threatening consequences. Recommendations for treatment of NM fluctuations are summarized in Figure 1. (5)

Conclusion: This exceptional case describes a PD patient without cardiovascular risk factors who suffered severe hearth dysautonomia occurring during an OFF period that put her life at risk. Although dysautonomic signs should be considered as part of PD symptoms it should be noted that they can be a true emergency to provide timely and targeted treatment.

Figure 1

References: Chou KL, Stacy M, Simuni T, Miyasaki J, Oertel WH, Sethi K, et al. The spectrum of “OFF” in Parkinson’s disease: What have we learned over 40 years? Vol. 51, Parkinsonism and Related Disorders. Elsevier Ltd; 2018. p. 9–16.
2. Antonini A, Martinez-Martin P, Chaudhuri RK, Merello M, Hauser R, Katzenschlager R, et al. Wearing-OFF scales in Parkinson’s disease: Critique and recommendations. Vol. 26, Movement Disorders. 2011. p. 2169–75.
3. Witjas T, Kaphan ; E, Azulay ; J P, Blin ; O, Ceccaldi ; M, Pouget ; J, et al. Nonmotor fluctuations in Parkinson’s disease Frequent and disabling. 2002.
4. Martínez-Fernández R, Schmitt E, Martinez-Martin P, Krack P. The hidden sister of motor fluctuations in Parkinson’s disease: A review on nonmotor fluctuations. Vol. 31, Movement Disorders. John Wiley and Sons Inc.; 2016. p. 1080–94.
5. Franke C, Storch A. Nonmotor Fluctuations in Parkinson’s Disease. In: International Review of Neurobiology. Academic Press Inc.; 2017. p. 947–71.
6. Brun L, Lefaucheur R, Fetter D, Derrey S, Borden A, Wallon D, et al. Non-motor fluctuations in Parkinson’s disease: Prevalence, characteristics and management in a large cohort of parkinsonian outpatients. Clin Neurol Neurosurg. 2014;127:93–6.

« Back to 2024 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/when-off-can-cost-life-myocardial-infarction-due-to-spontaneous-coronary-dissection-as-a-catastrophic-manifestation-in-advanced-parkinsons-disease/