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[Spasm in a single coronary artery]
Insights
This study reports a rare case of coronary artery spasm in a patient with a single coronary artery. Calcium antagonists effectively treated the patient's angina, highlighting diagnostic challenges.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- A 52-year-old male presented with exertional and resting angina, confirmed by exercise stress testing and myocardial scintigraphy.
- Initial coronary angiography revealed a rare single coronary artery anomaly originating from the right coronary ostium.
Observation:
- The anomalous left coronary artery coursed between the aorta and pulmonary artery.
- Effort-induced angina was initially attributed to extrinsic compression, but resting angina and failed beta-blocker therapy suggested other mechanisms.
- An ergometrine test induced significant occlusion in the right coronary artery, consistent with coronary artery spasm and Prinzmetal angina.
Findings:
- Coronary artery spasm was diagnosed in a patient with a single coronary artery anomaly.
- The spasm occurred independently of the anomalous vessel's course.
- Calcium antagonist drugs provided complete relief from anginal symptoms.
Implications:
- This case underscores the diagnostic complexities associated with co-existing coronary artery anomalies and coronary spasm.
- The potential for misdiagnosis and the importance of provocative testing are highlighted.
- Prompt recognition and appropriate pharmacotherapy are crucial for managing such rare cardiovascular conditions.
Abstract:
A 52 year old man presented with effort and resting angina with positive exercise stress testing and myocardial scintigraphy. The initial coronary angiogram showed a single coronary vessel arising from the right coronary ostium dividing into a right coronary artery with a normal trajectory lined with a few non stenotic atheromatous plaques and a left coronary artery which passed between the aorta and pulmonary artery to reach the left atrioventricular groove. At first, it was suggested that the angina was due to compression of the left coronary vessel by the great arteries during effort, but this mechanism could not explain attacks of resting angina and the failure of betablocker therapy. An ergometrine test performed during repeat coronary angiography induced almost complete occlusion of the right coronary vessel and Prinzmetal diaphragmatic ischaemia. The anginal attacks were completely suppressed by Calcium antagonist drugs. The association of coronary spasm and a single coronary artery is rare; only one case has been previously reported. We do not believe that there was a relationship between the two phenomena in our case: the spasm occurred at a distance from the aberrant course of the vessel. The authors emphasise the diagnostic problems and the potential danger of this association.