Coronary spasm in acute myocardial infarction

Area of Science:

• Cardiology
• Vascular Medicine
• Internal Medicine

Background:

• Acute myocardial infarction (MI) can present with complex underlying causes.
• Coronary artery vasospasm, or Prinzmetal angina, is a less common but significant etiology for MI.

Observation:

• A 30-year-old male experienced an acute anterolateral myocardial infarction.
• He developed unstable angina post-MI, necessitating percutaneous transluminal coronary angioplasty.
• Recurrent coronary lesions, responsive to intracoronary nitrate, suggested a vasospastic component.

Findings:

• A diagnosis of Prinzmetal (vasospastic) angina was established as the cause of the myocardial infarction.
• Treatment with a calcium antagonist and long-acting oral nitrate led to symptom resolution.
• The patient remained asymptomatic during a six-week outpatient follow-up.

Implications:

• This case highlights the importance of considering vasospastic angina in young patients with myocardial infarction.
• Prompt diagnosis and appropriate pharmacotherapy (calcium channel blockers, nitrates) are crucial for managing Prinzmetal angina.
• Effective management can lead to favorable long-term outcomes and symptom-free recovery.