BLOCKED CORONARY ARTERY DUE TO CORONARY SPASM TREATED WITH STENT INSERTION: A SUB-OPTIMAL RESULT?
AbstractMyocardial infarction (MI) is an extremely common cause of chest pain. MI can be acute with ST elevation (STEMI) or non-STEMI (NSTEMI). Coronary artery spasm can be severe enough to cause occlusion of the coronary arteries particularly with an exaggerated response in regions of coronary atheroma and plaque ulceration. It is not uncommon for coronary spasm to be mistaken with acute thrombotic occlusion of the coronary artery. We describe a case of a 42-year old man with known cardiac risk factors presents with chest pain for few hours to a tertiary centre hospital. A coronary angiogram showed occlusion of the right epicardial coronary artery with a severe spasm at the level of the atheroma. The initial coronary stent which was deformed because of intense pressure of spasm required another stent to be placed within the first stent. Diltiazem and Nitrates were started as secondary prevention treatment to reduce effect of coronary spasm. The patient made an uneventful recovery and was discharged home with no sequelae over the next 3 years follow up.Keywords: Myocardial infarction; Coronary angiogram; Coronary spasm; Stent
Vincent GM, Anderson JL, Marshall HW. Coronary spasm producing coronary thrombosis and myocardial infarction. N Engl J Med 1983;309(4):220–3.
Yasue H, Omote S, Takizawa A, Nagao M, Miwa K, Ranaka S. Circadian variation of exercise capacity in patients with Prinzmetal's variant angina: role of exercise. Circulation 1979;59(5):938–48.
Yasue H, Kugiyama K. Coronary spasm: clinical features and pathogenesis. Intern Med 1997;36(11):760–5.
Williams MJ, Restieaux NJ, Low CJ. Myocardial infarction in young people with normal coronary arteries. Heart 1998;79(2):191–4.
Yasue H, Nakagawa H, Itoh T, Harda E, Mizuno Y. Coronary artery spasm-clinical features, diagnosis, pathogenesis, and treatment. J Cardiol 2008;51(1):2–17.
Tanabe Y, Itoh E, Suzuki K, Ito M, Hosaka Y, Nakaqawa I, et al. Limited role of coronary angioplasty and stenting in coronary spastic angina with organic stenosis. J Am Coll Cardiol 2002;39(7):1120–6.