Coronary vasospasm inducing dynamic left ventricular outflow tract obstruction

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Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm
06:18

Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm

Published on: September 17, 2021

L T Kuo1, C H Wang, M J Hung

  • 1Department of Medicine, Chang Gung Medical College, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China.

Texas Heart Institute Journal
|October 27, 2001
PubMed

Insights

Coronary vasospasm can cause dynamic left ventricular outflow tract obstruction, leading to myocardial infarction. Prompt diagnosis and treatment, including nitroglycerin, are crucial for patient outcomes.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine

Background:

  • Acute myocardial infarction and cardiogenic shock necessitate rapid diagnosis and intervention.
  • Dynamic left ventricular outflow tract obstruction can complicate cardiac emergencies.

Observation:

  • An 80-year-old male presented with acute anterior-wall myocardial infarction and cardiogenic shock.
  • Echocardiography showed systolic anterior motion of mitral leaflets causing severe left ventricular outflow tract obstruction.
  • Coronary angiography revealed normal arteries, but ergonovine testing induced left coronary artery constriction.

Findings:

  • Coronary vasospasm was identified as the cause of coronary artery constriction.
  • The coronary artery spasm precipitated the dynamic left ventricular outflow tract obstruction.
  • Chest pain and ECG changes correlated with the vasospasm event.

Implications:

  • Coronary vasospasm should be considered in cases of myocardial infarction with left ventricular outflow tract obstruction.
  • Early detection and treatment of coronary vasospasm are vital.
  • Intracoronary nitroglycerin can effectively relieve vasospasm-induced obstruction.

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