<b>Pure Ventricular Septal Myocardial Infarction in a Young Man With Coronary Artery Ectasia</b>

Abstract

SUMMARYThe case of a 30-year-old man with myocardial infarction localized in the interventricular septum is described. Coronary angiography performed on day 28 after the onset of symptoms revealed ectasia in the right and left coronary arteries, but no overt stenotic or occlusive lesions were present. Spasm was induced in the first septal branch of the left anterior descending artery by an acetylcholine provocation test, and single photon emission computed tomography myocardial perfusion imaging showed a reduced thallium-201 uptake localized in the interventricular septum. (Int Heart J 2006; 47: 131-137) Key words: Coronary artery ectasia, Coronary vasospasm, Pure septal infarction PURE septal infarction is a rare type of myocardial infarction, 1) and is often difficult to diagnose from variations in the ECG patterns.2) On the other hand, there is a high incidence of vasospastic angina in the Japanese population and coronary vasospasm is thought to be heavily involved in the pathogenesis of acute myocardial infarction.3,4) Here, we report our experience of a rare case of pure septal infarction that may have been caused by coronary vasospasm provoked in the first septal branch of the ectatic left anterior descending artery in a 30-year-old man. CASE REPORTThe patient was a 30-year-old man with hypercholesterolemia who was a heavy smoker, had no history of collagen disease or Kawasaki disease, and no family history of coronary artery disease. The plasma levels of total cholesterol and low-density lipoprotein cholesterol were 294 and 160 mg/dL, respectively, but he had no history of familial hypercholesterolemia. He presented to our hosFrom the Departments of 1 Cardiology, and

A Case of Isolated Septal Myocardial Infarction: Myocardial Perfusion-Metabolism Mismatch as a Tool for Diagnosis

“…Electrocardiographic changes are reported to vary in patients with septal myocardial infarction. 1,2,5 By contrast, nuclear imaging with thallium-201 and I-123-BMIPP (to determine perfusion-metabolism mismatch) was informative despite the relatively small amount of infarction and the uncommon site limited to the mid-septum.…”