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Updated: Jul 29, 2026

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

[A case of painless myocardial injury probably caused by coronary artery spasm]

F Satoh1, M Horimoto, J Hirokawa

  • 1Division of Cardiology, Sapporo National Hospital.

Kokyu to Junkan. Respiration & Circulation
|October 1, 1992
PubMed

Insights

Coronary artery spasm, not blockage, can cause heart attacks. This study shows acetylcholine-induced spasm mimicked heart attack symptoms, resolving with medication, highlighting spasm as a cause of myocardial injury.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Acute myocardial infarction is typically associated with coronary artery occlusion.
  • Electrocardiogram (ECG) findings of ST-segment elevation and depression can indicate myocardial infarction.

Observation:

  • A 53-year-old male presented with ECG changes suggestive of myocardial infarction but had intact coronary arteries on angiography.
  • Intracoronary acetylcholine administration provoked diffuse coronary artery spasm, reproducing the patient's ECG abnormalities.
  • Spasm and ECG changes resolved with isosorbide dinitrate administration.

Findings:

  • Coronary artery spasm can induce ST-segment changes mimicking acute myocardial infarction.
  • Myocardial injury, indicated by slight creatine kinase elevation, can result from coronary spasm.

Implications:

  • Coronary artery spasm should be considered in the differential diagnosis of myocardial infarction, especially with non-obstructive coronary arteries.
  • Pharmacological provocation testing is crucial for diagnosing vasospastic angina.
  • Understanding coronary spasm mechanisms can lead to improved diagnostic and therapeutic strategies for ischemic heart disease.

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