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Left main coronary artery spasm--a rare entity as a cause of myocardial infarction in a patient

Fahad Ali1, Haroon A Faraz, Muhammad Umer Siddiqui

  • 1Heart & Vascular Institute, Harper Hospital, 4160 John R, Suite 510, Detroit, MI 48201, USA.

The Journal of Invasive Cardiology
|February 8, 2013
PubMed

Insights

Coronary artery spasm can mimic coronary artery disease (CAD), leading to unnecessary procedures. This case highlights left main coronary artery spasm, a rare condition, and its successful management.

Area of Science:

  • Cardiology
  • Vascular Medicine

Background:

  • Coronary artery disease (CAD) is a leading cause of death in the US.
  • Coronary artery spasm can present as ischemic chest pain, mimicking CAD and leading to misdiagnosis or unnecessary interventions.
  • Left main coronary artery spasm is a rare but critical condition.

Observation:

  • A 49-year-old female presented with recurrent chest pain initially deemed atypical.
  • Myocardial perfusion imaging suggested reversible ischemia, potentially due to artifact.
  • Medical management for presumed ischemia was ineffective.

Findings:

  • Left heart catheterization raised suspicion for vasospasm.
  • Intracoronary nitroglycerin administration resolved the apparent stenosis, confirming coronary artery spasm.
  • The patient's symptoms resolved after diagnosis and treatment.

Implications:

  • Coronary artery spasm should be considered in patients with unexplained chest pain, even if atypical.
  • While vasodilators are first-line treatment, refractory cases may require interventions like stenting or bypass surgery.
  • Accurate diagnosis of coronary spasm can prevent invasive procedures for non-atherosclerotic causes of ischemia.
Abstract

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