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(Circulation. 2006;113:e689-e690.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Coronary Artery Spasm

Vinod Raxwal, MD; Kamal Gupta, MD

From Kansas University Medical Center, Kansas City, Kan.

Correspondence to Vinod Raxwal, MD, Kansas University Medical Center, 3901 Rainbow Blvd, 1001 Eaton Bldg, MS 3006, Kansas City, KS 66212. E-mail vraxwal@kumc.edu

An extract of the first 100% of the full text is provided, because this article has no abstract.

A 50-year-old male patient presented with severe chest pain and right arm tightness. On arrival, he was hypotensive and had an initial slow atrial fibrillation with acute ST-segment elevation across the anterior and inferior leads (Figure 1). This required external pacing as well as atropine. The patient underwent urgent diagnostic coronary angiography that revealed a severely diseased, small-caliber right coronary artery with 100% distal cutoff before its bifurcation (Figure 2); 25% distal left main coronary artery stenosis with a diffusely diseased left anterior descending coronary artery from the ostium to the apex; and a circumflex artery with 50% proximal stenosis (Figure 3). Intracoronary nitroglycerin and nicardipine were injected, which resulted in complete resolution of stenosis (Figure 4 and Figure 5). The ST-segment elevation on the ECG subsequently resolved, and the patient returned to sinus rhythm. The patient had a peak troponin value of 0.29 and preserved left ventricular function with no wall motion abnormalities.

View larger version (115K): [in this window] [in a new window]   Figure 1. ECG showing ST-segment elevation.

View larger version (151K): [in this window] [in a new window]   Figure 2. Angiogram of the right coronary artery.

View larger version (157K): [in this window] [in a new window]   Figure 3. Angiogram of the left coronary artery.

View larger version (164K): [in this window] [in a new window]   Figure 4. Angiogram of the right coronary artery after vasodilator administration.

View larger version (166K): [in this window] [in a new window]   Figure 5. Angiogram of the left coronary artery after vasodilator administration.

Disclosures

None.

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Circulation 2006 113: 1717. [Extract] [Full Text]