Acute myocardial infarction with normal coronary arteries: a possible manifestation of the billowing mitral leaflet syndrome.

Abstract

The findings in four young patients with the billowing mitral leaflet syndrome who presented with evidence of acute myocardial infarction are reported. Because technically adequate coronary arteriograms demonstrated patent vessels and the electrocardiograms initially showed pronounced elevation of the ST segments as occurs in Prinzmetal's angina, it is postulated that spasm of normal coronary arteries was the operative factor. Scrutiny of those cases of clinically apparent ischemic heart disease with normal coronary angiograms is suggested to establish whether there is in fact a causal relationship with the billowing mitral leaflet syndrome.

Prinzmetal's angina with documented coronary artery spasm. Treatment and follow-up.

“…The left ventricular angiogram and selective coronary arteriograms were recorded on 35 mm cineangiographic film at 30 frames per second; they were interpreted independently by three observers unaware of the patient's clinical diagnosis. Seventeen of the 18 There was no correlation between the site of this myocardial infarction and the subsequent ST segment elevation. Symptoms were present from one to eight weeks (average 441 weeks) before the patients were clinically diagnosed as having variant angina.…”

“…An increased incidence of mitral valve prolapse in the presence of acute myocardial infarction with normal coronary arteries and coronary artery spasm has been reported. [17][18][19] The use of oral isosorbide dinitrate was effective in 10 of the 12 patients (including two of the surgically treated group) who continued to have attacks of Prinzmetal's angina. Four of the six surgically treated patients were pain free without 41uckell, McLaughlin, Morch, Wigle, Adelman drugs.…”

“…Over a four-year period, 18 patients fulfilling Prinzmetal's original criteria2 were diagnosed as having variant angina. Each had one or more episodes of chest pain with documented electrocardiographic ST segment elevation ( Fig.…”

Unusual case of acute coronary syndrome: inferior wall myocardial infarction 19 years young male presented with fever and right ankle cellulites treated with tissue plasminogen activator and its out come

“…There was a successful thrombolysis done with the tissue plasminogen agent which was tenectaplase which we used during the episode as it showed an accurate result in a young patient of myocardial infarction where the left ventricle ejection function was also preserved and the coronary angiography also normal during the study. 11,12 Hence, the complain to needle time is early there are result suggestive of better outcome.…”

Mitral Valve Prolapse and Spasm of Normal Coronary Arteries: Report of Four Cases and Review of the Literature

“…and coronary spasm. [15][16][17][18][19] Several lines of evidence point to underlying ischemia causing chest pain in MVP patients including electrocardiographic abnormalities, 1-5 arrhythmias '20-2:1 increased myocardial lactate production in MVP patients during ventricular pacing, 21 myocardial infarction 1;),2;) and sudden death. 26 Early speculation that coronary spasm caused chest pain in patients with MVP was based on circumstantial evidence such as documented myocardial infarction in a small number of patients with MVP and angiographically normal coronary arteries and occasional reports of ST segment elevation in MVP patients during pain.ls While several series showed angiographic evidence of coronary spasm in a few patients with MVP, 14,17,HJ the spasm often occurred around the catheter tip.17 Ergonovine testing in MVP patients with atypical chest pain has been largely unrewarding.…”