Simultaneous multivessel coronary spasm causing acute myocardial infarction: a case report.

Area of Science:

• Cardiology
• Interventional Cardiology
• Emergency Medicine

Background:

• Spontaneous multivessel coronary artery spasm is an infrequent cause of acute myocardial infarction (AMI).
• Documenting simultaneous spasm across three coronary arteries during an AMI event is exceptionally rare.
• Early diagnosis and intervention are critical for managing AMI.

Observation:

• A 79-year-old male presented with severe chest pain and syncope, indicative of AMI.
• Emergency left coronary angiography showed complete occlusion of the left anterior descending and left circumflex arteries.
• Right coronary angiography revealed 99% stenosis in the right coronary artery.

Findings:

• Intracoronary administration of nicorandil led to the resolution of all coronary artery occlusions.
• Post-treatment angiography confirmed the absence of organic stenosis or thrombus, indicating vasospasm as the cause.
• This case represents the first documented instance of simultaneous 3-vessel coronary artery spasm during AMI, visualized via emergency angiography.

Implications:

• Highlights the potential for multivessel coronary artery spasm to precipitate AMI.
• Emphasizes the diagnostic value of emergency coronary angiography in identifying vasospasm.
• Suggests that prompt vasodilator therapy can be effective in treating acute coronary events caused by spasm.