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Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm
Published on: September 17, 2021
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Coronary artery spasm: An often overlooked diagnosis
Oluwaseun Davies1, Olumide Ajayeoba1, Damian Kurian2
1Department of Internal Medicine, Columbia University at Harlem Hospital Center, New York, USA.
Summary
Coronary vasospasm, often overlooked, can cause heart attacks. This case highlights cocaine and smoking as triggers, emphasizing prompt diagnosis and treatment for recovery.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Emergency Medicine
Background:
- Coronary vasospasm is an underdiagnosed cause of acute coronary syndromes.
- Diagnosis is challenging due to its transient nature and overlap with atherosclerosis.
- Risk factors include smoking and illicit drug use, such as cocaine.
Purpose of the Study:
- To present a case of coronary vasospasm triggered by cocaine use.
- To highlight the diagnostic challenges and successful management of coronary vasospasm.
- To underscore the importance of considering vasospasm in patients with risk factors presenting with chest pain.
Main Methods:
- Case report of a middle-aged male with chest discomfort and diaphoresis.
- Electrocardiogram (ECG) revealed ST elevation, resolving with nitroglycerin.
- Coronary angiography identified significant stenosis in the left anterior descending artery.
Main Results:
- The patient's symptoms and ECG changes resolved rapidly with nitroglycerin, suggesting vasospasm.
- Angiography confirmed a 70% stenosis, consistent with vasospasm superimposed on potential underlying disease.
- Percutaneous coronary intervention led to an asymptomatic outcome.
Conclusions:
- Coronary vasospasm can be precipitated by cocaine use and smoking.
- Early recognition and treatment with vasodilators are crucial for managing vasospastic angina.
- Aggressive risk factor modification and intervention are vital for preventing recurrent events.
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