Coronary Vasoespasm – ABC CARDIOL

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Research Letter

Interpreting Acute Myocardial Infarction 40 Years Later. Evolution of Knowledge: What is the Best Explanation?

Vitor Coutinho Andrade et al. Paulo Cury Rezende Whady Hueb José Antonio Franchini Ramires

Introduction

Plaque rupture and erosion are the most common immediate pathologies associated with acute myocardial infarction. However, other mechanisms must be considered. The reported case occurred at a time when percutaneous or pharmacological coronary revascularization were not the standard treatment, which sparked discussion about these other mechanisms, as well as the possible advantages associated with the myocardial revascularization procedures.

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Exuberant Vasospastic Angina Simulating Severe Three-Vessel Disease

Bruno Marmelo et al. Luís Abreu Júlio Gil Pedro Ferreira José Cabral

A 56-year-old Caucasian male, came to our hospital complaining of thoracic oppression at exertion and sometimes occurring at rest, lasting for a few minutes. The patient was an active smoker, with a moderate alcohol consumption habit and had had an episode of unstable angina two months earlier. At that episode, two drug-eluting stents were implanted, one in the distal anterior descending artery and the other in the proximal first diagonal artery. The ECG showed mild ST-elevation in V1-V3 and a T-wave inversion in V3-V5. There was a slight increase in Troponin I up to 0.24 ng/mL but the blood tests were otherwise unremarkable. The patient was admitted at the coronary unit and was scheduled for urgent coronary angiogram. The exam revealed severe and diffuse stenosis in the territories of the right and left coronary arteries with slow flow (TIMI 1-2), sparing only the stented segments (picture/). The administration of 2 mg of intracoronary isosorbite dinitrate reverted all the stenosis but slow flow (TIMI 2) was still observed in the left coronary artery. Hence, the diagnosis of vasospastic angina was made. The patient was successfully controlled with calcium antagonists and has remained asymptomatic.

Vasospastic angina is commonly misinterpreted as acute coronary syndrome. Although its pathophysiology is not fully understood, it usually has a favorable long-term prognosis, although coronary artery spasms may have an important role in arrhythmia generation and subsequent cardiac arrest.

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Interpreting Acute Myocardial Infarction 40 Years Later. Evolution of Knowledge: What is the Best Explanation?

Introduction

Exuberant Vasospastic Angina Simulating Severe Three-Vessel Disease

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Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)