A Case Report of Acute Myocardial Infarction Induced by Coronary Spasm

Abstract

SummaryA 53-year-old male complaining of chest pain was admitted to our hospital with suspected acute myocardial infarction (AMI). Emergent coronary angiography (CAG) determined a totally occluded middle right coronary artery (RCA). Thrombus aspiration was conducted, followed by intravascular ultrasound (IVUS) imaging. Diffuse intima plus media thickness was identified at the obstruction site and a thrombus was observed proximally to the occlusion site on IVUS. Following isosorbide dinitrate (ISDN) administration, dilatation of the RCA was confirmed. IVUS study indicated the luminal dilatation was achieved by the release of the diffuse intima plus media thickening. Of note, plaque volume showed no significant difference after administration of ISDN at any vessel site. These results clearly show that luminal dilatation and vessel dilatation were achieved from the redistribution of plaque volume (intima plus media). A follow-up CAG showed no significant stenosis in the RCA. After a provocation test using methylergometrine maleate, the RCA was totally occluded at the very site of the initial event. The involvement of vasospasm as a cause of AMI in the present case was doubly confirmed with characteristic IVUS images of vasospasm in the acute phase and with a provocation test at follow-up. (Int Heart J 2013; 54: 237-239) Key words: Intravascular ultrasound, Intima and media thickening C oronary artery vasospasm has been shown to play an important role in the pathogenesis of ischemic heart disease, variant angina, myocardial infarction, and ventricular arrhythmia. [1][2][3] Previous studies have shown that the etiology of spasm is due to transient abnormal or hypersensitive response of vascular smooth muscle to various stimuli and that the atherosclerosis is invariably present at the site of focal vasospasm. 4,5) Previous intravascular ultrasound (IVUS) and optical coherence tomography (OCT) studies have reported the morphological features of vasospastic lesions. [6][7][8][9][10][11] However, most of the data were obtained in a spastic lesion that was artificially induced by the administration of a vasoconstrictor (acetylcholine or ergonivine). In the present report, we report IVUS images from a patient with ST elevation type acute myocardial infarction (STEMI) due to vasospasm. Case ReportA 53-year-old male complaining of chest pain at rest was admitted to our hospital.The patient had experienced 2-3 minutes of similar episodes once a month for 2 to 3 years. This time, his chest pain had lasted for more than 3 hours prior to the admission.Laboratory data showed a white blood cell count of 14460/mm 3 , creatine kinase (CK) of 3075 IU/L, CK-MB of 86.9 IU/L, and troponin-I of 16.2 ng/mL. An electrocardiogram (ECG) showed ST elevation in the II, III, and aV F leads and ST depression in the aV L lead. The data indicated an acute myocardial infarction. Emergent coronary catheterization was performed.Emergent coronary angiography showed a totally occluded RCA ( Figure 1A). Immediate percutaneous coronary intervention (P...

Right coronary artery ostial stenosis associated with idiopathic ventricular tachycardia ablation

“…Case reports have demonstrated diffuse intimal thickening associated with vasospasm using intravascular imaging 11, 12. Although no consensus exists regarding specific findings on intravascular imaging associated with vasospasm, because the intimal thickening observed in our case was eccentric rather than diffuse (Figure 3C, top), we believe vasospasm as the cause of the RCA stenosis is unlikely.…”

Coronary arterial spasm detected by coronary computed tomography angiography and confirmed by intravascular ultrasound

“…IVUS was helpful for confirming the diagnosis of coronary spasm in this case. The IVUS findings at the coronary spasm sites showed morphological changes in the vascular wall, such as atherosclerosis, negative remodeling, diffuse intima, thick media, and wrinkles in the internal elastic membrane even in the absence of a significant coronary stenosis [8] , [9] , [10] .…”

Multi-vessel intractable coronary spasm development in a patient with aborted sudden cardiac death: a case study with intravascular ultrasound findings

“…Ota et al reported the IVUS findings from a case of ST-segment elevation myocardial infarction caused by coronary spasm. The IVUS findings at the spasm site showed diffuse intima and media thickening immediately after thrombectomy, which disappeared after nitrate administration [7]. Park et al reported on a young patient who experienced two episodes of sudden cardiac arrest due to intractable coronary spasm and was successfully treated with stenting after IVUS evaluation.…”