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Hypovolemia-induced severe coronary spasm leading to acute myocardial infarction

Hm Hadi1, Sp D'souza, M El-Omar

  • 1Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom.

Experimental and Clinical Cardiology
|July 25, 2012
PubMed

Insights

Severe dehydration can trigger acute ST-elevation myocardial infarction (STEMI) via coronary artery spasm. This case highlights hypovolemia as a novel STEMI trigger, resolved with fluid resuscitation and nitrates.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Critical Care Medicine

Background:

  • Acute ST-elevation myocardial infarction (STEMI) is commonly linked to coronary artery spasm.
  • While various triggers exist, hypovolemia has not been previously identified as a cause of STEMI.
  • Coronary artery spasm can lead to myocardial ischemia and infarction.

Observation:

  • A patient developed acute STEMI four days after major colonic surgery.
  • The patient was severely dehydrated (hypovolemic).
  • Coronary angiography showed underfilled coronary arteries with significant multifocal spasm.

Findings:

  • Hypovolemia was identified as a potential trigger for acute STEMI in this case.
  • Aggressive fluid repletion and intracoronary nitrate administration led to the resolution of coronary artery spasm.
  • The patient's STEMI largely resolved following interventions targeting hypovolemia and vasospasm.

Implications:

  • This case suggests hypovolemia should be considered in the differential diagnosis of STEMI, especially post-surgery.
  • Fluid resuscitation is a critical initial management strategy for STEMI potentially caused by hypovolemia-induced vasospasm.
  • Understanding novel triggers like dehydration can improve STEMI diagnosis and treatment protocols.

Keywords:
Coronary spasmHypovolemiaMyocardial infarctionSTEMI

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