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Anterior myocardial infarction with coronary thrombus formation secondary to acute coronary vasospasm. A case report
Insights
Young man experienced myocardial infarction without atherosclerosis, showing transient coronary artery thrombosis. Provocation tests revealed coronary spasm induced by ergometrine and hyperventilation, causing angina without ischemic ECG changes.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Medicine
Background:
- Acute myocardial infarction (heart attack) typically results from atherosclerosis in coronary arteries.
- This case presents a young male patient with myocardial infarction despite the absence of fixed atherosclerotic lesions.
Observation:
- The patient developed a transient thrombosis in the left anterior descending coronary artery shortly after the infarction.
- Recurrent angina pectoris prompted further investigation.
Findings:
- Provocation tests using ergometrine maleate and hyperventilation successfully induced coronary artery spasm.
- The induced coronary spasm was associated with angina pectoris but lacked electrocardiogram (ECG) evidence of ischemia.
Implications:
- Coronary artery spasm, even without atherosclerosis, can cause acute myocardial infarction and angina.
- These findings highlight the importance of considering coronary vasospasm in young patients presenting with myocardial infarction and angina, especially when traditional risk factors are absent.
Abstract:
An acute myocardial infarction in a young man when there was no fixed atherosclerotic lesion in the coronary arteries is reported. Soon after the myocardial infarction the patient was shown to have thrombosis in the anterior descending branch of the left coronary artery but this later disappeared. In view of recurrent angina pectoris, provocation tests were undertaken with ergometrine maleate, cold pressor and hyperventilation. Both the drug and the hyperventilation provoked coronary spasm accompanied by angina pectoris but no ECG evidence of ischaemia.