Asymptomatic Coronary-Artery Spasm

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     A 38-year-old man was scheduled to undergo invasive coronary angiography after cardiac scintigraphy revealed silent ischemia of the anterior myocardial wall. He was a smoker and had no other medical problems apart from occasional atypical chest pain. Coronary angiography showed chronic total occlusion of the proximal part of the left anterior descending coronary artery (LAD), clinically insignificant atherosclerotic plaque in the right coronary artery, and collateral circulation to the distal portion of the LAD. Treatment with a beta-blocker was begun, and the patient underwent multislice computed tomography (CT) of the coronary arteries 1 month later to better assess the distal part of the LAD. CT showed tight bifocal stenoses in the first segment of the right coronary artery (Panel A). The patient was asymptomatic, but because coronary-artery spasm was strongly suspected, multislice CT was repeated 1 week later, with the use of intravenous isosorbide dinitrate as a vasodilator, and showed no stenoses in the right coronary artery (Panel B). The patient underwent successful coronary-artery bypass in which the left internal thoracic artery was anastomosed to the LAD, and he was doing well 1 year later. These findings show the ability of multislice CT to detect coronary-artery spasm in the right coronary artery and emphasize the utility of nitrate administration, as routinely performed during conventional invasive angiography.

    Michele Hamon, M.D.

    Martial Hamon, M.D.

    Centre Hospitalier Universitaire de Caen

    14033 Caen, France

    hamon-m@chu-caen.fr

    http://www.100md.com/html/DirDu/2007/01/16/34/24/49.htm