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Large myocardial infarction and a severe spasm of the left coronary artery

B Mark1, T Scheidt, U Zeymer

  • 1Herzzentrum Ludwigshafen, Kardiologie Klinikum der Stadt Ludwigshafen, Bremserstrasse 79, 67073 Ludwigshafen, Germany. MarkB@klilu.de

Zeitschrift Fur Kardiologie
|December 16, 2004
PubMed

Insights

Acute myocardial infarction with normal coronary arteries can be challenging. This case highlights left coronary artery spasm diagnosed with contrast-enhanced cardiac MRI, treated successfully with intracoronary medications.

Area of Science:

  • Cardiology
  • Diagnostic Imaging

Background:

  • Acute myocardial infarction (AMI) diagnosis can be uncertain when initial coronary angiography reveals normal arteries.
  • Coronary artery spasm is a potential cause of AMI that requires specific diagnostic approaches.

Observation:

  • A 41-year-old woman presented with acute anterior myocardial infarction.
  • Initial coronary angiography showed no obstructive coronary artery disease, leading to diagnostic uncertainty.

Findings:

  • Severe spasm of the left coronary artery was identified as the cause of infarction.
  • Contrast-enhanced cardiac magnetic resonance imaging confirmed the diagnosis of myocardial infarction and coronary artery spasm.
  • Treatment with intracoronary nitroglycerine and verapamil successfully resolved the spasm.

Implications:

  • This case underscores the importance of considering coronary artery spasm in patients with AMI and normal coronary arteries.
  • Contrast-enhanced cardiac MRI is a valuable tool for diagnosing coronary artery spasm and associated myocardial infarction.
  • Intracoronary vasodilator therapy offers an effective treatment option for severe coronary artery spasm-induced myocardial infarction.

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