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Spontaneous multi-focal coronary artery spasm: a case report
Mohammad Ali Ostovan1, Mahdi Sajedi Khanian1, Sahand Hamidi1
1Cardiology Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran ; Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Journal of Cardiovascular and Thoracic Research
|October 26, 2016
Summary
Spontaneous coronary artery vasospasm can mimic coronary artery disease, leading to misdiagnosis. Intracoronary nitroglycerin effectively relieved severe spasm in a myocardial infarction case, confirming the diagnosis.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Spontaneous coronary artery vasospasm (SCAS) is a significant cause of acute chest pain syndromes.
- Diagnosing diffuse multifocal coronary artery spasm presents challenges and can be misidentified as diffuse coronary artery disease.
- SCAS can lead to acute myocardial infarction, sometimes necessitating interventions like fibrinolytic therapy.
Observation:
- A case of acute myocardial infarction was presented, initially treated with fibrinolytic therapy due to severe coronary artery spasm.
- Coronary angiography revealed multiple narrowings, leading to the patient being scheduled for percutaneous coronary intervention (PCI).
- Intracoronary (IC) nitroglycerin administration resulted in the complete disappearance of all observed lesions.
Findings:
- The administration of intracoronary nitroglycerin completely resolved the coronary artery narrowings.
- The diagnostic challenge of differentiating coronary artery spasm from coronary artery disease was highlighted.
- The case confirmed a diagnosis of severe coronary artery spasm as the cause of myocardial infarction.
Implications:
- Intracoronary nitroglycerin is crucial for accurately diagnosing coronary artery spasm, especially when it mimics coronary artery disease.
- Prompt and accurate diagnosis of SCAS can prevent unnecessary invasive procedures like PCI.
- Understanding SCAS is vital for managing acute chest pain syndromes and preventing myocardial infarction.
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