Coronary Artery Vasospasm with Acute Myocardial Infarction in a Male Patient: Case Report

We present a 48-year-old male patient with a history of classic precordialgia, ST-segment elevation in inferior leads (II, III and aVF), with troponin and CK-MB (creatine kinase-MB) elevated on the day of admission that received conventional anti-ischemic treatment. Hemodynamically stable, symptom-free, is referred to cardiac catheterization. In the selective catheterization of the left coronary artery, a moderate lesion was observed in the middle third of the anterior descending coronary artery; in the right coronary artery, a subocclusive proximal lesion with TIMI (thrombolysis in myocardial infarction) II. We performed a single projection and opted for angioplasty. Before, it was decided to re-evaluate the left coronary artery, and it was observed in the contrast test that anterior descending artery was occluded. Intra-coronary nitroglycerin and new contrast injection were performed, which showed totally open descending artery with TIMI III, without obstructive lesions as initially suggested, and improvement of pain. It was a severe coronary vasospasm. When a new contrast injection was performed in the right coronary, with a therapeutic catheter, the disappearance of the subocclusive lesion and the presence of a normal coronary flow were observed, although there was a moderate plaque in its proximal third, which motivated the maintenance of angioplasty with stent placement in a proximal third of right coronary artery. During the passage of the intracoronary guidewire it was once again evident that diffuse coronary artery vasoreactivity was present; the procedure was successfully completed.