A case report of acute myocardial infarction induced by coronary spasm. Intravascular findings

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Hideaki Ota1, Yoshiaki Kawase, Hiroki Kondo

  • 1Department of Cardiology, Gifu Heart Center, Japan.

International Heart Journal
|August 9, 2013
PubMed

Insights

This study reveals that vasospasm, not plaque, caused acute myocardial infarction (AMI) in a patient. Intravascular ultrasound confirmed vasospasm resolved with medication, and a provocation test recreated the blockage.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Acute myocardial infarction (AMI) necessitates prompt diagnosis and intervention.
  • Coronary artery occlusion can result from various pathologies, including thrombosis and vasospasm.
  • Intravascular ultrasound (IVUS) provides detailed imaging of coronary artery morphology.

Observation:

  • A 53-year-old male presented with chest pain, diagnosed with AMI due to a totally occluded right coronary artery (RCA).
  • Initial IVUS revealed diffuse intima-media thickening and proximal thrombus at the occlusion site.
  • Administration of isosorbide dinitrate (ISDN) led to luminal and vessel dilatation, attributed to plaque redistribution.

Findings:

  • IVUS demonstrated that ISDN-induced dilatation resulted from the redistribution of intima-media thickness, not a change in plaque volume.
  • Follow-up coronary angiography showed no significant stenosis after ISDN treatment.
  • A methylergometrine provocation test re-induced total RCA occlusion at the initial site, confirming vasospasm.

Implications:

  • This case highlights the critical role of vasospasm in AMI, even with apparent thrombotic occlusion.
  • IVUS is valuable in differentiating vasospasm from obstructive plaque in acute coronary syndromes.
  • Understanding vasospasm mechanisms is crucial for effective AMI management and prevention.

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