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. 1986 Jun;13(2):223–231.

Left Coronary Artery Spasm Causing Severe Left Ventricular Dysfunction Without Myocardial Infarction

Robert J Freedman Jr 1, Francisco Fuentes 1, Richard W Smalling 1, Richard L Kirkeeide 1, Rosalyn P Sterling 1, William E Walker 1, K Lance Gould 1
PMCID: PMC324630  PMID: 15227365

Abstract

This report describes a patient with persistent, recurrent left anterior descending coronary artery spasm, which causes marked left ventricular dysfunction in a clinical course that is typical of acute myocardial infarction with hyperacute electrocardiographic changes. However, after emergency coronary artery bypass surgery, the patient had complete reversal of left ventricular dysfunction, with no residual evidence of acute myocardial infarction by electrocardiograph or gated blood pool imaging and no CPK enzyme rise. The patient therefore demonstrates that coronary spasm in some instances clearly precedes the sequence of pathophysiologic events leading to acute myocardial infarction. Our report also demonstrates for the first time in man that massive left ventricular dysfunction may occur in this intermediate coronary syndrome, presenting clinically as impending myocardial infarction.

With aggressive surgical intervention and emergency bypass surgery, left ventricular function was restored to normal. Despite the semantic problems of categorizing such patients as having impending myocardial infarction, the severe left ventricular dysfunction and alarming course of this patient's illness was resolved by emergency surgery, suggesting that, in some instances, aggressive therapy is warranted.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Banka V. S., Bodenheimer M. M., Helfant R. H. Relation between progressive decreases in regional coronary perfusion and contractile abnormalities. Am J Cardiol. 1977 Aug;40(2):200–205. doi: 10.1016/0002-9149(77)90009-1. [DOI] [PubMed] [Google Scholar]
  2. Bentivoglio L. G., Ablaza S. G., Greenberg L. F. Bypass surgery for Prinzmetal angina. Arch Intern Med. 1974 Aug;134(2):313–316. [PubMed] [Google Scholar]
  3. Brown B. G., Bolson E., Frimer M., Dodge H. T. Quantitative coronary arteriography: estimation of dimensions, hemodynamic resistance, and atheroma mass of coronary artery lesions using the arteriogram and digital computation. Circulation. 1977 Feb;55(2):329–337. doi: 10.1161/01.cir.55.2.329. [DOI] [PubMed] [Google Scholar]
  4. Brown B. G., Bolson E., Petersen R. B., Pierce C. D., Dodge H. T. The mechanisms of nitroglycerin action: stenosis vasodilatation as a major component of the drug response. Circulation. 1981 Dec;64(6):1089–1097. doi: 10.1161/01.cir.64.6.1089. [DOI] [PubMed] [Google Scholar]
  5. Buxton A. E., Goldberg S., Harken A., Hirshfield J., Jr, Kastor J. A. Coronary-artery spasm immediately after myocardial revascularization: recognition and management. N Engl J Med. 1981 May 21;304(21):1249–1253. doi: 10.1056/NEJM198105213042101. [DOI] [PubMed] [Google Scholar]
  6. DeWood M. A., Spores J., Notske R. N., Lang H. T., Shields J. P., Simpson C. S., Rudy L. W., Grunwald R. Medical and surgical management of myocardial infarction. Am J Cardiol. 1979 Dec;44(7):1356–1364. doi: 10.1016/0002-9149(79)90453-3. [DOI] [PubMed] [Google Scholar]
  7. DeWood M. A., Spores J., Notske R., Mouser L. T., Burroughs R., Golden M. S., Lang H. T. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980 Oct 16;303(16):897–902. doi: 10.1056/NEJM198010163031601. [DOI] [PubMed] [Google Scholar]
  8. Ganz W., Marcus H. S. Failure of intracoronary nitroglycerin to alleviate pacing-induced angina. Circulation. 1972 Nov;46(5):880–889. doi: 10.1161/01.cir.46.5.880. [DOI] [PubMed] [Google Scholar]
  9. Gould K. L. Dynamic coronary stenosis. Am J Cardiol. 1980 Feb;45(2):286–292. doi: 10.1016/0002-9149(80)90647-5. [DOI] [PubMed] [Google Scholar]
  10. Gould K. L., Kelley K. O. Physiological significance of coronary flow velocity and changing stenosis geometry during coronary vasodilation in awake dogs. Circ Res. 1982 May;50(5):695–704. doi: 10.1161/01.res.50.5.695. [DOI] [PubMed] [Google Scholar]
  11. Hillis L. D., Braunwald E. Coronary-artery spasm. N Engl J Med. 1978 Sep 28;299(13):695–702. doi: 10.1056/NEJM197809282991305. [DOI] [PubMed] [Google Scholar]
  12. Madias J. E. The syndrome of variant angina culminating in acute myocardial infarction. Circulation. 1979 Feb;59(2):297–306. doi: 10.1161/01.cir.59.2.297. [DOI] [PubMed] [Google Scholar]
  13. Maseri A., L'Abbate A., Baroldi G., Chierchia S., Marzilli M., Ballestra A. M., Severi S., Parodi O., Biagini A., Distante A. Coronary vasospasm as a possible cause of myocardial infarction. A conclusion derived from the study of "preinfarction" angina. N Engl J Med. 1978 Dec 7;299(23):1271–1277. doi: 10.1056/NEJM197812072992303. [DOI] [PubMed] [Google Scholar]
  14. Oliva P. B., Breckinridge J. C. Arteriographic evidence of coronary arterial spasm in acute myocardial infarction. Circulation. 1977 Sep;56(3):366–374. doi: 10.1161/01.cir.56.3.366. [DOI] [PubMed] [Google Scholar]
  15. PRINZMETAL M., KENNAMER R., MERLISS R., WADA T., BOR N. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med. 1959 Sep;27:375–388. doi: 10.1016/0002-9343(59)90003-8. [DOI] [PubMed] [Google Scholar]
  16. Peter T., Norris R. M., Clarke E. D., Heng M. K., Singh B. N., Williams B., Howell D. R., Ambler P. K. Reduction of enzyme levels by propranolol after acute myocardial infarction. Circulation. 1978 Jun;57(6):1091–1095. doi: 10.1161/01.cir.57.6.1091. [DOI] [PubMed] [Google Scholar]
  17. Severi S., Davies G., Maseri A., Marzullo P., L'Abbate A. Long-term prognosis of "variant" angina with medical treatment. Am J Cardiol. 1980 Aug;46(2):226–232. doi: 10.1016/0002-9149(80)90062-4. [DOI] [PubMed] [Google Scholar]
  18. Smalling R. W., Fuentes F., Matthews M. W., Freund G. C., Hicks C. H., Reduto L. A., Walker W. E., Sterling R. P., Gould K. L. Sustained improvement in left ventricular function and mortality by intracoronary streptokinase administration during evolving myocardial infarction. Circulation. 1983 Jul;68(1):131–138. doi: 10.1161/01.cir.68.1.131. [DOI] [PubMed] [Google Scholar]
  19. Waters D. D., Szlachcic J., Miller D., Theroux P. Clinical characteristics of patients with variant angina complicated by myocardial infarction or death within 1 month. Am J Cardiol. 1982 Mar;49(4):658–664. doi: 10.1016/0002-9149(82)91943-9. [DOI] [PubMed] [Google Scholar]
  20. Waters D. D., Theroux P., Crittin J., Dauwe F., Mizgala H. F. Previously undiagnosed variant angina as a cause of chest pain after coronary artery bypass surgery. Circulation. 1980 Jun;61(6):1159–1164. doi: 10.1161/01.cir.61.6.1159. [DOI] [PubMed] [Google Scholar]
  21. Wood J. M., Hanley H. G., Entman M. L., Hartley C. J., Swain J. A., Busch U., Chang C. H., Lewis R. M., Morgan W. J., Schwartz A. Biochemical and morphological correlates of acute experimental myocardial ischemia in the dog. IV. Energy mechanisms during very early ischemia. Circ Res. 1979 Jan;44(1):52–61. doi: 10.1161/01.res.44.1.52. [DOI] [PubMed] [Google Scholar]

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