Key result
Intracoronary nitrates reverse acute multivessel spasm, and combination vasodilators prevent recurrence at follow-up.
Why the study?
Coronary artery spasm can produce clinical scenarios similar to acute STEMI, including ST-segment elevation, cardiac enzyme elevation, and echocardiographic regional wall motion abnormalities.
Case Report (n=1)
No
Spontaneous multivessel coronary artery spasm can mimic acute STEMI with total occlusion of multiple coronary arteries and hemodynamic instability, and can be effectively treated with intracoronary nitrates followed by calcium channel blockers, nitrates, and nicorandil.
Answers are grounded in this paper and cite their sources.
Alerts clinicians to multivessel spasm mimicking STEMI on angiography; leaves open validation of maintenance regimens in prospective studies.
Acute coronary syndrome (ACS) is a critical disease especially in case of acute ST segment elevation myocardial infarction (STEMI). Acute STEMI typically shows ST segment elevation on electrocardiography (ECG), elevation of serum cardiac enzyme and abnormal regional wall motion on echocardiogram. However, coronary artery spasm (CAS), subarachnoid hemorrhage, pheochromocytoma, electroconvulsive treatment, and apical ballooning syndrome(superscript 1-3) can also result in similar clinical scenarios. Here, we report a case of a 65-year-old male who was admitted to our hospital because of severe chest pain associated with cold sweating and syncope. Coronary angiography (CAG) revealed spontaneous total occlusion of the left anterior descending artery (LAD) and right coronary artery (RCA) accompanied with severe chest pain, ST segment elevation, and hypotension. The severe coronary spasms were relieved via intracoronary administration of isosorbide dinitrate. After discharge, the patient was treated with verapamil, oral long-acting nitrate, and nicorandil. No chest pain with cold sweating or syncope occurred at OPD follow-up.
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Hsieh et al. (2010) conducted a case report in Severe spontaneous multiple coronary artery spasm (total occlusion of LAD and RCA) (n=1). Intracoronary isosorbide dinitrate followed by oral verapamil, long-acting nitrate, and nicorandil was evaluated on Relief of coronary artery spasm and recurrence of chest pain with cold sweating or syncope at outpatient follow-up. Intracoronary isosorbide dinitrate relieved severe spontaneous multivessel coronary spasm, and maintenance verapamil, long-acting nitrate, and nicorandil prevented symptom recurrence at follow-up.
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