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[Spasm of the coronary arteries in acute myocardial infarct]
Insights
Coronary artery spasms can mimic blockages in patients with myocardial infarction. Further use of spasm-relaxing drugs during coronary angiography may improve diagnosis and treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Context:
- Acute myocardial infarction (MI) presents diagnostic challenges.
- Coronary angiography is a key diagnostic tool for MI.
- Unexplained non-visualization of coronary artery segments occurs in MI patients.
Purpose:
- To investigate the role of coronary artery spasm in the angiographic appearance of myocardial infarction.
- To evaluate the diagnostic utility of nitroglycerine in identifying coronary spasm during angiography.
Summary:
- Emergency coronary angiography in 36 myocardial infarction patients revealed coronary artery spasms in some cases.
- Nitroglycerine administration confirmed spasm by demonstrating the entire vessel length.
- Non-visualized distal coronary segments, initially appearing occluded, were not anatomically blocked in post-mortem studies, suggesting spasm as an alternative explanation.
Impact:
- Findings suggest coronary artery spasm is a significant factor in the angiographic presentation of acute myocardial infarction.
- Highlights the potential for increased use of thrombolytics and spasmolytics during coronary angiography for improved diagnostic accuracy and therapeutic intervention.
Abstract:
Emergency coronarography was performed in 36 patients with myocardial infarction. Spasms of the coronary artery supplying the area of the infarction were observed in some cases. The fact that the vessel was demonstrated along its entire length after 0.5 mg of nitroglycerine was placed under the tongue confirmed the existence of the spasm. In most patients with acute myocardial infarction the vessel supplying the area of the affected muscle has the appearance of a stump, i.e. its peripheral segments are not demonstrated. At the same time, in some patients, who died some time after the examination, anatomical study of the heart showed that these segments of the vessel were not occluded. Such an angiographic picture may also be explained by the spasm of the coronary arteries. The angiographic pattern of the coronary channel in patients with acute myocardial infarction suggests that coronarolytics and spasmolytics injected both intravenously and into the coronary vessel in coronarography may be used still more extensively.