A Case of Acute Myocardial Infarction due to Coronary Spasm that Resulted in Thrombi

Special Article - Thrombosis

Ann Hematol Oncol. 2017; 4(9): 1169.

A Case of Acute Myocardial Infarction due to Coronary Spasm that Resulted in Thrombi

Sadahiro H*, Takamichi M, Junji Y, Takamasa I, Keita W, Yuichiro S, Ryo M, Ryoichi M, Naoyuki M, Masahiro S, Tetsuo Y, Nobuhiro H, Yasutoshi N and Toshihiro N

Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan

*Corresponding author: Sadahiro H, Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonan-cho, Musashino-City, Tokyo 181-8610, Japan

Received: July 24, 2017; Accepted: August 17, 2017; Published: August 30, 2017


Acute coronary syndrome is caused by plaque rapture, but a few hypotheses state that coronary spasm causes acute myocardial infarction. We report a unique case of acute myocardial infarction that presented with coronary thrombi due to coronary spasm.

Keywords: Acute coronary syndrome; Vasospastic angina; Thrombosis; Angiography


ECG: Electrocardiogram; ACS: Acute Coronary Syndrome; LAD: Left Anterior Descending Artery; CAS: Coronary Arterial Spasm; NO: Nitrogen Monoxide; MDA-LDL: Malondialdehyde-Modified Low Density Lipoprotein; ACh: Acetylcholine

Case Presentation

An 82-year-old woman with chest pain was transferred to our hospital by ambulance. Electrocardiography (ECG) revealed STsegment depression in leads I, aVL, and V2–6, and positive troponin I expression. We made a diagnosis of acute coronary syndrome (ACS) and performed emergency coronary angiography. The coronary artery was neither tortuous nor sclerosed, but the filling defect hada “pebble” appearance in the distal portion of the left anterior descending (LAD) artery (Figure 1). Left ventriculography revealed hypokinesis of the cardiac apex (Figure 2A, 2B). She sometimes had chest pain at rest, and the culprit lesion was poorly atherosclerotic and distal; thus, we considered that the cause of the ACS was coronary spasm rather than simple plaque rupture. She was discharged from the hospital within 8 days, with no complications. Coagulation abnormalities and atrial fibrillation were not observed in the blood test and ECG monitoring. During the acute phase and after discharge, she received anticoagulation therapy, single antiplatelet therapy, and coronary vasodilator therapy containing a calcium antagonist. One year later, reexamination with coronary angiography was performed. The filling defect in the LAD artery disappeared, and no significant stenosis and dissection were observed. The left ventricular wall motion had improved (Figure 2C, 2D). Acetylcholine intracoronary administration induced coronary arterial spasm (CAS) with symptoms in both coronary arteries (Figure 3). She was diagnosed as having coronary vasospastic angina, was suspected to have caused the ACS.