Acute Myocardial Infarction with Coronary Artery Spasm on Coronary Angiogram

Choi, Dong Ju; Cho, Myeong Chan; Kim, June Soo; Kim, Young Kwon; Kim, Chee Jeong; Sohn, Dae Won; Lee, Myoung Mook; Park, Young Bae; Choi, Yun Sik; Seo, Jung Don; Lee, Young Woo

Abstract

Clinical characteristics and coronary angiographic findings were analyzed in seven cases of acute myocardial infarction with documented coronary artery spasm, which developed spontaneously(four cases) and was provoked by intravenous ergonovine maleate(three cases). All the patients were male and their ages ranged from 25 to 68 years. As to the characteristics of chest pain before the attack of acute myocardial infarction, angina at rest occurred in two cases, exertional angina in four cases, and no chest pain in one case. Infarction sites on electrocardiogram were anterior wall in five cases, inferior wall in one case and lateral wall in one case. Coronary angiogram revealed coronary artery spasm on left anterior descending artery in four cases, right coronary artery in two cases, and first diagonal branch and intermedius branch concomitantly in one case. Spasm occurred on underlying insignificant atherosclerotic lesion(less than 50% narrowing) in four cases and on the normal or near-normal coronary artery branches in three cases having significant atherosclerotic coronary lesion. Spasm developed at infarct-related arteries in all but one case. Repeated coronary artery spasms with reperfusion ventricular tachyarrhythmia were observed in one case during coronary angiography. In conclusion, coronary artery spasm is thought to play a significant role in the development of acute myocardial infarction.