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[Acute coronary syndrome due to coronary thrombus formed by severe coronary spasm: a case report]

Kohko Yamazaki1, Naoki Funayama, Hiroaki Okabayashi

  • 1Division of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo. koko@poplar.ocn.ne.jp

Journal of Cardiology
|October 19, 2007
PubMed

Insights

Severe coronary artery spasm, not plaque rupture, can cause thrombus formation and acute coronary syndrome. This case highlights spasm as a critical factor in heart attacks.

Area of Science:

  • Cardiology
  • Interventional Cardiology

Background:

  • Acute coronary syndrome (ACS) is often attributed to plaque rupture and thrombosis.
  • Understanding the diverse etiologies of ACS is crucial for effective treatment.

Observation:

  • A 47-year-old man presented with acute chest pain and ST-segment elevation myocardial infarction.
  • Coronary angiography revealed total occlusion of the right coronary artery, with thrombus identified.
  • Initial treatment with isosorbide dinitrate and urokinase successfully resolved the occlusion and thrombus.

Findings:

  • Follow-up angiography and intravascular ultrasound showed minimal plaque without rupture, suggesting non-atherosclerotic origins.
  • Provocation angiography demonstrated significant coronary artery spasm as the cause of occlusion.

Implications:

  • This case suggests severe coronary artery spasm alone can precipitate acute coronary syndrome by inducing thrombus formation.
  • Highlights the importance of considering coronary vasospasm in the differential diagnosis of ACS, even in the absence of significant obstructive coronary artery disease.

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