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[Two cases of acute myocardial infarction with simultaneous occlusions of two main branches]
Insights
Simultaneous occlusions in two major coronary arteries during acute myocardial infarction are rare. This case study highlights two instances, emphasizing the diagnostic challenges and potential causes like coronary vasospasm.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Acute myocardial infarction (AMI) typically involves single coronary artery occlusion.
- Simultaneous occlusion of two major coronary branches is exceptionally rare and diagnostically challenging prior to emergent coronary angiography (CAG).
Observation:
- Two cases of AMI with simultaneous occlusions in two main coronary arteries were identified.
- Case 1: A 77-year-old woman with complete occlusions of the right coronary artery (RCA) Segment 3 and left anterior descending artery (LAD) Segment 7.
- Case 2: A 58-year-old man with complete occlusions of the RCA Segment 2 and LAD Segment 6.
Findings:
- Emergent CAG revealed complete occlusions in both cases.
- Intracoronary thrombolysis (ICT) improved stenoses in both cases, with one artery recanalizing.
- Myocardial dual scintigraphy supported the diagnosis of simultaneous dual-branch occlusion.
Implications:
- This presentation underscores the importance of considering rare etiologies in complex AMI cases.
- Potential contributing factors include coronary vasospasm, hypercoagulable states, and reduced coronary pressure.
- Advanced imaging and prompt intervention are crucial for managing such rare myocardial infarction presentations.
Abstract:
Acute myocardial infarction with simultaneous occlusions of two main branches is very rare, and it is difficult to presume it before performing emergent CAG. We encountered two such cases recently. Case 1 was a 77 year-old woman. She was admitted to our hospital because of anterior chest pain. Emergent CAG disclosed complete occlusions of RCA-Segment 3 and LAD-Segment 7. ICT improved both of them to 90% stenoses. Case 2 was a 58 year-old man. He was admitted to our hospital because of upper abdominal pain. Emergent CAG disclosed complete occlusions of RCA-Segment 2 and LAD-Segment 6. ICT improved the former to 99% stenosis, and the latter recanalized. Myocardial dual scintigrams performed during the acute periods showed findings which were consistent with simultaneous occlusion of the two main branches in both cases. We could consider such reasons as coronary vasospasm, state of hyper-coagulability at the onset of myocardial infarction and depression of coronary pressure etc as possible causes of these cases.