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Coronary vasospasm inducing dynamic left ventricular outflow tract obstruction
1Department of Medicine, Chang Gung Medical College, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China.
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.
Abstract:
An 80-year-old man was admitted to the emergency department of our institution due to acute, anterior-wall myocardial infarction and cardiogenic shock. Two-dimensional echocardiography revealed systolic anterior motion of the mitral leaflets with severe left ventricular outflow tract obstruction. Although coronary angiography showed normal coronary arteries, an ergonovine provocation test induced diffuse coronary constriction of the left coronary artery, with chest pain, and ST-T changes seen on the electrocardiogram. These clinical signs caused us to suspect coronary spasm. The present case serves as a reminder that coronary vasospasm may be a factor in the development of dynamic left ventricular outflow tract obstruction. Early detection and intensive efforts to relieve vasospasm, including emergency coronary angiography and intracoronary injection of nitroglycerin, are essential.