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Resistant spontaneous coronary artery spasm

Kudret Keskin1, Alparslan Şahin2, Süleyman Sezai Yıldız1

  • 1Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Turk Kardiyoloji Dernegi Arsivi : Turk Kardiyoloji Derneginin Yayin Organidir
|November 6, 2015
PubMed

Insights

Coronary artery spasm is a critical consideration for myocardial infarction with normal coronary arteries. In refractory cases, catheter retraction and observation may resolve the spasm when vasodilators fail.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Myocardial infarction (MI) with normal coronary arteries (MINC) necessitates considering non-atherosclerotic causes like coronary artery spasm.
  • Coronary artery spasm can precipitate acute coronary syndromes, including MI, even without obstructive coronary artery disease.

Observation:

  • A 33-year-old woman presented with anterior myocardial infarction.
  • Coronary angiography demonstrated a normal left anterior descending artery and a new, complete occlusion of the circumflex artery during the procedure.
  • Intracoronary nitroglycerin up to 800 mcg was ineffective in relieving the circumflex artery occlusion.

Findings:

  • The case highlights a severe, nitroglycerin-resistant coronary artery spasm causing myocardial infarction.
  • Standard vasodilator therapy proved insufficient to address the acute arterial occlusion.

Implications:

  • This case suggests that in refractory coronary artery spasm unresponsive to vasodilators, mechanical interventions like catheter retraction and a period of observation may be a viable strategy.
  • Clinicians should maintain a high index of suspicion for coronary artery spasm in MINC and consider alternative management approaches when initial treatments fail.

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