Inordinately Sluggish Coronary Artery Flow in an Angiographically Normal Coronary Artery

Abstract

A 53-year-old male smoker, without any significant medical history was admitted via the emergency room to the cardiac care unit due to a single episode of unstable angina lasting for approximately 10 minutes. Over the last one year he admits to symptoms indicative of effort angina of class II according to the Canadian Cardiovascular Society (CCS) classification. He had been submitted to an exercise stress test a year earlier which was characterized as positive based on clinical criteria only. On admission no ischemic ECG changes were noted; chest pain had subsided upon arrival to the emergency room, thus an ECG recording during the episode of chest pain was lacking. Cardiac enzymes were normal. However, due to the typical clinical presentation, prior history of effort angina and report of a positive exercise test in the past, a decision was made to proceed with cardiac catheterization, which was performed the following day. Coronary angiography revealed no significant atherosclerotic lesions, however an impressively sluggish flow was observed in the left anterior descending (LAD) coronary artery (Figure 1). During injection of contrast material into the left coronary artery, the left circumflex (LCx) coronary artery (panel A, left side) fills up quickly, while there is an inordinate delay of flow in the LAD which has only filled half-way (panel A, right side). Only several frames later when the circumflex has started to empty (panel B, left side), has the LAD filled up with the contrast material (panel B, right Images In medIcIne