Korean Circ J.  2012 Jan;42(1):50-53. 10.4070/kcj.2012.42.1.50.

A Case of Acute Myocardial Infarction With ST-Segment Elevation in a Lead Augmented Right Vector Caused by a Left Main Coronary Artery Vasospasm

• Jung KY
• Kang TS

• KMID: 2297908
• DOI: http://doi.org/10.4070/kcj.2012.42.1.50

Abstract

Diagnosing and selecting an appropriate treatment strategy for left main coronary artery (LMCA) obstruction is very important. Although this disease is not frequently encountered, it can cause severe hemodynamic deterioration resulting in a less favorable prognosis without a suitable management approach. Another aspect of LMCA that we must not overlook is coronary artery spasm, which can be an infrequent but important cause of acute coronary syndrome. Although it is rare, LMCA can cause critical complications. In this study, we report the case of a 35-year-old female who was admitted to the hospital with a diagnosis of acute myocardial infarction with ST-segment elevation in the aVR lead caused by a left main coronary spasm that was examined on intravascular ultrasound.

Keyword

Coronary artery vasospasm; Electrocardiography; Acute coronary syndrome

MeSH Terms

Acute Coronary Syndrome
Adult
Coronary Vasospasm
Coronary Vessels
Electrocardiography
Female
Hemodynamics
Humans
Myocardial Infarction
Prognosis
Spasm

Figure

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  Fig. 1 Initial electrocardiogram revealed a 2-mm ST segment depression in leads V3-6 and up to a 1-mm ST segment depression in leads I, aVL, II, aVF with a 2-mm ST-segment elevation in the aVR lead (arrows).

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  Fig. 2 Coronary angiography showing diffuse left main coronary artery vasospasm (A) and resolution of the spasm after administration of intracoronary nitrates (B).

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  Fig. 3 Coronary angiography showing normal right coronary artery.

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  Fig. 4 Intravascular ultrasound showing a minimal concentric plaque in the left main coronary artery.

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  Fig. 5 Follow up electrocardiogram (ECG) showing a normalized ST segment deviation after intracoronary nitrate.

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