068 Coronary spasm: a rare cause of myocardial infarction - 07/07/11
Résumé |
Introduction |
Acute myocardial infarction may also occur when the coronary arteries are normal or nearly normal. It affects primarily younger persons. The possible mechanisms underlying myocardial infarction with normal coronary arteries coronary vasospasm, thrombosis, embolization or minimal atherosclerosis.
Observation |
A 36-year-old lacting women was admitted to our center with constrective chest pain lasting for more than 30 minutes. She was a passive smoker and had no other risk factors for CAD, no prior history of chest pain and the family history was negative. Cardiovascular examination revealed no abnormal heart sound, gallop or murmur. The initial electrocardiogram revealed sinus rhythm with negative T waves in anterior leads. The occurence of myocardial infarction was confirmed by elevation of cardiac troponin. She was treated conventionally. The normokinesis of all wall motion has been shon by echocardiography, with normal left ventricular function.
Coronary angiography revealed an occlusion of the left anterior descending artery, avoided by nitrate intracoronary. Coronary spasm was suspected and she was started on calcium blockers. Two weeks after, contro coronary angiography revealed normal coronary arteries.
Conclusion |
Coronary artery spasm has been shown to cause myocardial infarction in patients with normal coronary arteries. Vasospasm can cause vascular endothelial injury leading to platelet aggregation and coagulation system activation with resultant thrombosis and myocardial infarction. Multislice computed tomography coronary angiography can be used as an alternative first-line imaging modality for the diagnosis of acute myocardial infaction in young patients thought to normal coronary arteries.
Le texte complet de cet article est disponible en PDF.Vol 3 - N° 1
P. 22 - janvier 2011 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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