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Herz

, Volume 40, Issue 2, pp 257–258 | Cite as

Diagnosis of myocardial infarction during long-standing coronary artery spasm and uptitration of nitroglycerin

  • A. AvciEmail author
  • E. Alizade
  • G. Acar
  • S. İzci
  • Ç. Geçmen
  • Z. Simsek
  • A.M. Esen
Image of the month

A 57-year-old man presented to our emergency service with typical angina pectoris of 5-h duration. Electrocardiography (ECG) revealed normal sinus rhythm without any ischemic signs and a heart rate of 74 bpm (Fig. 1). His blood pressure was 120/70 mmHg. The rest of the physical examination was unremarkable. The patient described having intermittent chest pain attacks at rest with a short duration of 3 or 5 min. To determine the etiology, transthoracic echocardiography (TTE) was performed after complete blood tests and cardiac biomarker measurements. TTE revealed hypokinesis in the anterior, anterior septal, and anterolateral segments of the left ventricle with an ejection fraction of 45–50 %. Without waiting for the results of the cardiac biomarkers, we performed coronary angiography because of the hypokinesis in the anterior segments and ongoing ischemia. Coronary angiography revealed about 95 % stenosis in the proximal part of left anterior descending artery (LAD) followed by a...

Diagnose eines Myokardinfarkts bei langanhaltendem Koronararterienspasmus und Nitroglyzeringabe

Notes

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Supplementary material

Video 1: Right cranial view of coronary angiography is showing vasospastic segments of left anterior descending artery. (AVI 1.4MB)

Video 2: Right caudal view of coronary angiography is showing vasospastic segments of circumflex artery and left anterior descending artery. (AVI 1.4MB)

Video 3: Right cranial view of coronary angiography is showing mild dilatation of left anterior descending artery after first injection of nitroglycerin into the coronary circulation. (AVI 1.3MB)

Video 4: Right cranial view of coronary angiography is showing further dilatation of left anterior descending artery after repeating injection of nitroglycerin into the coronary circulation. (AVI 1.7MB)

Video 5: Right caudal view of coronary angiography is showing dilatation of circumflex artery and left anterior descending artery after repeating injection of nitroglycerin into the coronary circulation. (AVI 1.7MB)

References

  1. 1.
    Ledakowicz-Polak A, Ptaszyński P, Polak Ł, Zielińska M (2009) Prinzmetal’s variant angina associated with severe heart rhythm disturbances and syncope: a therapeutic dilemma. Cardiol J 16(3):269–272PubMedGoogle Scholar
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    Yasue H, Kugiyama K (1997) Coronary spasm: clinical features and pathogenesis. Intern Med 36(11):760–765CrossRefPubMedGoogle Scholar
  3. 3.
    Kusama Y, Kodani E, Nakagomi A et al (2011) Variant angina and coronary artery spasm: the clinical spectrum, pathophysiology, and management. J Nippon Med Sch 78(1):4–12CrossRefPubMedGoogle Scholar

Copyright information

© Urban & Vogel 2015

Authors and Affiliations

  • A. Avci
    • 1
    Email author
  • E. Alizade
    • 1
  • G. Acar
    • 1
  • S. İzci
    • 1
  • Ç. Geçmen
    • 1
  • Z. Simsek
    • 2
  • A.M. Esen
    • 1
  1. 1.Cardiology ClinicKartal Koşuyolu Heart Research and Training HospitalKartal, IstanbulTurkey
  2. 2.Cardiology Clinicİskilip Atıf Hoca Government HospitalÇorumTurkey

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