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Left main coronary artery spasm in a hyperthyroid patient with suspected acute coronary syndrome

De-Zhao Wang1, Hong-Yu Hu2, Qiang Fu3

  • 1De-zhao Wang, Department of Cardiology, Tiantan Hospital, Capital Medical University, Beijing, China.

Pakistan Journal of Medical Sciences
|December 20, 2013
PubMed

Insights

This case study highlights rare left main coronary artery (LMCA) vasospasm in a hyperthyroid patient. Treatment for hyperthyroidism and vasospasm resolved chest pain, suggesting a link.

Area of Science:

  • Cardiology
  • Endocrinology

Background:

  • Left main coronary artery (LMCA) vasospasm is an uncommon condition.
  • Hyperthyroidism is associated with various cardiovascular complications.
  • Coronary artery vasospasm can mimic acute coronary syndrome.

Observation:

  • A patient presenting with symptoms of acute coronary syndrome was found to have a 60% stenosis in the LMCA.
  • Intracoronary nitroglycerin administration resolved the stenosis on repeat angiography.
  • Intravascular ultrasound (IVUS) confirmed the absence of significant underlying atherosclerotic stenosis.

Findings:

  • The patient was diagnosed with LMCA vasospasm, potentially linked to their hyperthyroid state.
  • Treatment including anti-thyroid medication and anti-spasmodic agents led to symptom resolution.
  • This case suggests hyperthyroidism may induce coronary hypersensitivity, contributing to LMCA vasospasm.

Implications:

  • Hyperthyroidism may predispose individuals to coronary vasospasm, including in the critical LMCA.
  • Intravascular ultrasound (IVUS) can be a valuable tool in diagnosing coronary vasospasm when angiography is equivocal.
  • Understanding this association can improve the diagnosis and management of cardiac events in hyperthyroid patients.

Keywords:
Coronary angiographyHyperthyroidismIntravascular ultrasoundLeft main coronary arteryVasospasm

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