Clinical Study of Coronary Heart Disease with Non-Atherosclerotic Lesion and with Normal Coronary Arteries

In the majority of patients with ischemic heart disease, atherosclerotic change of major coronary artery were thought to be its causative disease. However, since the development of selective coronary angiographic technique, some observers have recently pointed to the existence of myocardial ischemia without atherosclerotic change in coronary angiogram. Some of these patients have normal coronary artery and others have non-atheromatous changes in coronary arteries.Study of the underlying causative disease of the myocardial ischemia is very important to discuss the treatment and prognosis of the patients. To evaluate the underlying causative disease of myocardial ischemia, clinical data and selective coronary angiogram were analysed.1) Non-atherosclerotic coronary heart disease (Table 2, 3 & 4)In our clinic, a significant non-atheromatous stenosis of coronary artery was often seen in aortitis syndrome. Myocardial infarction and angina pectoris due to this syndrome were found in ten patients, two of the former and eight of the latter. An autopsied case of 24 year-old young man had a sudden death due to a proliferative ostial stenosis of left main coronary artery (Table 2). In various disease, three patients of myocardial infarction and eleven of angina pectoris were found including congenital coronary abnormalities (coronary aneurysm, rudimentary hypoplastic right coronary artery), MCLS and miscellaneous diseases (Table 4). It might be concluded that aortitis syndrome and rudimentary hypoplastic right coronary artery were a important underlying diseases of non-atherosclerotic coronary abnormalities.2) Myocardial infarction and angina pectoris with the normal coronary artery (Table 5)Two cases of acute myocardial infarction and eight angina pectoris associated with arteriographically normal coronary arteries were reported in this paper. Spasm of right coronary artery was suggested as etiology of acute myocardial infarction in two cases. In angina pectoris with ST elevation or depression during attack, coronary spasm without evidence of atherosclerotic coronary stenosis was demonstrated angiographically by the stress of exercise and medicament.It was suggested that myocardial squeezing, angiographically functional obstruction during systole, which found in 55 pts. (9.1%), might be the cause of a ischemic heart disease and a conduction disturbance.