SUMMARY A 37-year-old man presented with an evolving inferior myocardial infarction. Coronary angiography performed within 3 hours after the onset of the pain showed spasm of the right coronary artery and the presence of intracoronary thrombi. After resolution of spasm and the disappearance of thrombi, angiography revealed nearly normal coronary arteries. An ergonovine test was positive when the patient was not taking medication and became negative when he was taking diltiazem. The course was uncomplicated, and after 9 months the patient is free of angina.WHAT CAUSES myocardial infarction (MI) in patients with angiographically normal or nearly normal coronary arteries remains unclear. Some studies have suggested a role for coronary artery spasm,' but the importance of thrombosis has been better documented, since coronary angiography is performed within the first hours of acute MI.4 I We recently studied a patient with an acute MI associated with probable coronary artery spasm, coronary thrombosis and only slight irregularities of the coronary arterial tree.Case Report A 37-year-old white man was admitted to the coronary care unit (CCU) for prolonged anginal chest pain. He had no history of hypertension, diabetes mellitus or lipid abnormalities, but had smoked 30 cigarettes daily for 20 years. He had a 1-year history of infrequent spontaneous and exertional substernal pain. At 11:30 a.m. on December 23, 1981, he experienced a severe typical anginal pain and was admitted to the CCU at 12:45 p.m. Physical examination was normal. The chest x-ray revealed a heart of normal size. Serum creatine kinase was 23 U (normal range 0-140 U/ml). Hemoglobin was 13.2 g. An ECG showed normal sinus rhythm and 0.2 mV of ST-segment elevation in leads III and VF ( fig. 1). An inferior myocardial infarction was suspected and the patient was considered for percutaneous transluminal coronary recanalization. showed only a discrete stenosis at the site of the previous obstruction and the presence of intracoronary filling defects consistent with thrombi ( fig. 3). A second left ventriculogram showed local contraction improvement, moderate diaphragmatic and posterobasal hypokinesia and a global ejection fraction of 61%. Because of the cardiac massage, intracoronary injection of streptokinase was cancelled. The patient received i.v. heparin, 360 mg, and i.v. nitroglycerin, 25 mg daily. His clinical course was uncomplicated (no pain, arrhythmia or heart failure). The maximum CK value of 1000 U/ml was reached on December 24. The ECG ( fig. 4) fig. 5). An ergonovine test was performed in the CCU, off medication, using a progressive protocol as previously described.6 Ten minutes after the 0. 2-mg injection of ergonovine maleate, the patient experienced typical anginal pain and the ECG ( fig. 4) showed 0.2 mV of ST-segment elevation in the inferior leads, which was reversed with 0.
An unusual association of agenesis of the left internal carotid artery and coarctation of the aorta is reported. There was also an aneurysm of the thoracic aorta distal to the coarctation. The subclavian artery was obstructed and revascularization occurred through the vertebral artery via anastomoses with the occipital artery. An embryological hypothesis for this association is proposed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.