Left main coronary artery spasm in a hyperthyroid patient with suspected acute coronary syndrome

Dezhao Wang,Xu Hua,Wei Chen,Buxing Chen,Qiang Fu,Hongyu Hu

doi:10.12669/pjms.295.3703

Abstract

The left main coronary artery (LMCA) vasospasm is rare. We report a suspected acute coronary syndrome patient with hyperthyroidism who had LMCA vasospasm. Coronary angiogram showed 60% stenosis at LMCA. After administering nitroglycerin, re-angiography showed no significant stenosis. Then we evaluated LMCA lesion using intravascular ultrasound (IVUS) showing no significant stenosis. We considered that it was a LMCA vasospasm and may be assosiated with hyperthyroid state. After anti-thyroid and anti-spasm treatment, chest pain subsided. In conclusion, hyperthyroidism induced coronary hypersensitivity may contribute to LMCA vasospasm as seen in this case. IVUS may be useful to identify coronary vasospasm.

Highlights

INTRODUCTIONIt is well known that coronary artery spasm is an important cause of acute coronary syndrome (ACS)
CASE REPORTIt is well known that coronary artery spasm is an important cause of acute coronary syndrome (ACS)
We report the case of a 50-year-old man who was diagnosed with hyperthyroidism and suspected ACS and experienced a left main coronary artery (LMCA) vasospasm when undergoing coronary angiography

Summary

INTRODUCTION

It is well known that coronary artery spasm is an important cause of acute coronary syndrome (ACS). A vasospasm of the left main coronary artery (LMCA) is rare. We report the case of a 50-year-old man who was diagnosed with hyperthyroidism and suspected ACS and experienced a LMCA vasospasm when undergoing coronary angiography. We present a 50-year-old man who was admitted to our department complaining of intermittent chest pain. He was a driver by profession and his chest pain was more frequent during driving. The electrocardiogram (ECG) was normal while pain free (Fig.1A). ECG revealed 0.1 mm ST segment depression in leads V56 and 0.05 mm ST segment elevation in the aVR lead (Fig.1B) during chest pain. Coronary angiogram showed approximately 60% stenosis of the LMCA in its ostium (Fig.2A) and a normal right coronary artery. After 7 days of the treatment, the patient’s episodes of chest pain has subsided

DISCUSSION

CONCLUSION