Angiographic evidence of myocardial squeezing accompanying tachyarrhythmia as a possible cause of myocardial infarction

The coronary arteriogram of a 52-year-old man with Basedow's disease and who was suffering from myocardial infarction following rapid atrial fibrillation, showed severe myocardial squeezing without organic stenosis. Angiographically, the functional obstructive lesion was always observed both at systole and diastole during atrial pacing, 150 beats per minute, and suggests that myocardial squeezing may be the cause of myocardial infarction following tachyarrhythmia.     

Unusual cause of myocardial infarction

The authors report the case of a woman with an acute myocardial infarction in whom coronary angiography performed a few hours earlier was completely normal. Transoesophageal echocardiography showed two thrombi in the left atrial appendage confirming the thromboembolic mechanism of this infarct.     

An uncommon cause of myocardial infarction

A 73 year-old lady with hypertension and chronic atrial fibrillation (AF) developed chest pain followed by ventricular fibrillation (VF) cardiac arrest. Her electrocardiogram post-cardioversion revealed inferior ST-elevation myocardial infarction (MI). Her coronary arteries were angiographically normal. Contrast-enhanced cardiac magnetic resonance(CE-CMR) demonstrated both an inferior subendocardial infarction and left atrial (LA) appendage thrombus suggesting cardioembolism as the most likely cause of her presentation.     

Clinical characteristics associated with myocardial infarction, arrhythmias, and sudden death in patients with vasospastic angina

A total of 349 patients with vasospastic angina were followed in eight centers in Japan for a period of 3.4 +/- 0.1 years (mean +/- SE). Ninety-eight percent of patients were treated with calcium blockers. Twenty-one episodes of myocardial infarction occurred in 18 patients (5%), including two fatal myocardial infarctions. The rate of myocardial infarction was higher (p less than .01) in patients with a fixed stenosis of 90% or greater than in patients with a fixed stenosis of less than 90% or normal coronary arteries. Myocardial infarctions occurred predominantly during hospital stays or at a time when the frequency of vasospastic angina increased. There were five sudden deaths (2%). Only one patient suffering sudden death had a fixed stenosis of 75% or greater. Serious arrhythmias were noted in 49 patients (14%). The risk of arrhythmias did not depend on the presence of a fixed stenosis of 75% or greater. These results suggest that cardiac events are rather infrequent in Japanese patients with vasospastic angina who are receiving treatment with calcium blockers and that the presence of a severe fixed stenosis markedly increases the risk of myocardial infarction but not the risk of arrhythmias.     

Repetitive myocardial infarction in a young woman with vasospastic coronary artery disease

The angiographic study of a young woman with previous anteriormyocardial infarction and normal coronary arteries is presented.During coronary angiography the patient had multiple episodesof spasm in the right coronary artery and an acute inferiormyocardial infarction.     

Clinical and angiographic characteristics of acute myocardial infarction caused by vasospastic angina without organic coronary heart disease.

BACKGROUND: Vasospastic angina (VA) can occasionally cause acute myocardial infarction (AMI). METHODS AND RESULTS: From January 2003 to June 2005, coronary spastic angina was diagnosed in 292 patients by performing spasm provocation tests. Among the 292 patients, 21 (7.2% of all the VA patients) had an AMI. There were 20 patients who initially visited the emergency room for AMI without suffering prior VA. One patient with a history of VA had an AMI when he discontinued his medication. Among the 21 VA patients with AMI, 14 had experienced severe emotional stress before they visited the emergency room. The spasm provocation test showed that the VA patients with AMI had more multivessel and diffuse spasm than the VA patients without AMI (p<0.001). CONCLUSION: Clinically, the VA patients with AMI usually had their first symptom of VA as the severe chest pain of AMI. Two-thirds of the VA patients with AMI had experienced emotional stress before their AMI. Angiographically, the spasm provocation test for VA patients with AMI showed more multivessel and diffuse spasm than in VA patients without AMI.     

An unusual cause of myocardial infarction?

A young woman is described with acute inferior myocardial infarctiondue to a thrombus in the ascending aorta. The aetiology, therole of risk factors, the diagnostic value of transoesophagealechocardiography and angiography, and therapy, are discussed.     

Behcet disease: uncommon cause of myocardial infarction

A 25-year-old man who was known to have Beh?et's syndrome and who has no coronary risk factors suffered an acute anterior wall myocardial infarction which was complicated by a ventricular fibrillation. The diagnosis of Beh?et's syndrome was based on recurrent thrombophlebitis, genital and oral aphtoses, posterior uveitis, positive pathergy test and HLAB51. About 20 cases of myocardial infarction were reported in the literature but the etiopathogeny, the causal relationship and the treatment are yet unknown.     

An unusual cause of right ventricular myocardial infarction

A unique case of right ventricular myocardial infarction complicating an acute inferior-posterior myocardial infarction in a patient with a single left coronary artery is described. The clinical, electrocardiographic, and hemodynamic features of right ventricular myocardial infarction and the angiographic patterns of anomalous single coronary arteries are reviewed.     

Myocardial bridging: a cause of myocardial infarction?

A 50-year-old man was admitted to hospital because of severe and progressive chest pain at rest. Selective coronary arteriography revealed occlusion of the left anterior descending artery at the origin of an intramural course. Intracoronary thrombolysis restored the patency of the otherwise completely normal vessel but did not fully prevent myocardial infarction.     

Atrial myxoma: an unusual cause of myocardial infarction

A 55-year-old woman had an inferior myocardial infarction due to a coronary artery embolus from a large, polypoid, left atrial mass. The mass had an irregular surface and was prolapsing into the mitral valve orifice during diastole. Coronary angiography revealed tumor vascularization next to the right coronary artery. The other coronary arteries were normal. The tumor was removed surgically; pathologic examination confirmed the diagnosis of myxoma. The patient did well after the procedure and was discharged on postoperative day 10.     

Thoracic myelitis as a possible cause of myocardial infarction

During the course of an inflammatory process in the thoracic part of the spinal cord, a previously healthy male suffered two myocardial infarctions in separate coronary territories. A coronary angiogram revealed only minor wall changes in one coronary artery. We hypothesize that the myocardial infarctions may have been caused by vasospastic reactions secondary to his spinal cord pathology, and present the case report and a review of the literature.     

Electrocardiographic evidence of myocardial salvage after thrombolysis in acute myocardial infarction

There is a need for a simple clinical measurement that will indicate the extent of myocardial salvage after successful thrombolysis. This study examined whether coronary artery reperfusion reduced the infarct size as assessed electrocardiographically after thrombolytic treatment. The sum of the (sigma) ST segment area in leads showing ST segment elevation in the 12 lead electrocardiogram at presentation was used as an index of potential myocardial injury (initial ischaemic index). The evolved infarct size at 48 h was assessed by a QRS scoring system. Two groups of patients, both admitted with anterior myocardial infarction within 6 h of onset, were studied. Group 1 (n = 35) received analgesia only and group 2 (n = 33) received thrombolytic treatment either by the intracoronary (streptokinase, n = 13) or intravenous route (anistreplase, n = 20). Reperfusion was assessed angiographically. The mean (SD) potential infarct size assessed by the initial ischaemic index was similar in both groups (group 1, sigma ST area = 115 (60) mm2 and group 2 = 126 (77 mm2). The QRS score representing evolved infarct size was significantly lower in the treated group (4.1 (2.5] than in group 1 (7.8 (2.6]. The 95% confidence intervals for QRS scores based on the admission sigma ST area from patients with successful reperfusion were applied to a third set of patients (n = 22) to test the ability of the admission ST area (myocardial injury) to predict the QRS score accurately. While patients with successful reperfusion had significantly lower QRS scores than those who did not (4.5 (3.1) versus 9.3 (3.4)), the wide confidence intervals caused by inter-individual variability precluded an accurate prediction of the QRS score in an individual from the sigma ST area at time of presentation. There was no difference in infarct size in patients treated early (相似文献   

Myocardial bridging as a cause of acute anterior myocardial infarction

Myocardial bridging is systolic compression of an epicardial coronary arterial segment by overlying myocardium. It is a rare coronary anomaly, which is generally considered to be benign. It has been suggested that myocardial ischaemia may be seen. In this article, a case of myocardial infarction caused by myocardial bridging is presented.