Epicardial Coronary Spasm in Left Anterior Descending Artery and Coronary Microvascular Spasm in Right Coronary Artery

Figures

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  Figure 1. Epicardial Coronary Spasm in LAD and Coronary Microvascular Spasm in RCA The SPT of the LCA demonstrated a 99% spasm in the LAD with delayed coronary blood flow, associated with clinical chest pain by the administration of 50 μg acetylcholine, leading to a diagnosis of epicardial VSA. After the relief of the chest symptoms and electrocardiographic changes, The patient underwent SPT of the RCA. After intracoronary administration of 50 μg Ach, clinical chest pain was observed with new ST-segment depression in leads Ⅱ, Ⅲ, aVF in the absence of significant epicardial artery stenosis. Ach = acetylcholine; LAD = left anterior descending; LCA = left coronary artery; RCA = right coronary artery; SPT = spasm provocation test; VSA = vasospastic angina.

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  Figure 2. Timeline of Interventional Diagnostic Procedures The patient underwent coronary angiography with SPT for LCA and RCA. Subsequently, physiological assessments for microvascular function were also performed on both LAD and RCA. CFT indicated CMD in RCA territory (CFR 1.26, IMR 120.24). LAD CFT demonstrated normal CFR and IMR in LAD territory (CFR 3.42, IMR 13.7). On the basis of these SPT findings and physiological test results, the patient first received a diagnosis of VSA involving the LAD, MVS involving the RCA, normal coronary function in LAD territory, and CMD in RCA. CFT was repeated after a 30-minute interval in RCA, showing in significant improvement (fractional flow reserve 0.93, CFR 5.67, IMR 27.4, respectively). CAG = coronary angiography; CFT = coronary function test; CFR = coronary flow reserve; CMD = coronary microvascular dysfunction; IMR = index of microcirculatory resistance; MVS = microvascular spasm; other abbreviations as in Figure 1.