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Case Reports
. 2014 Jun 11:2014:bcr2014204408.
doi: 10.1136/bcr-2014-204408.

Coronary spasm as the cause of myocardial ischaemia in a patient with anomalous origin of the left anterior descending artery from the proximal right coronary artery

Jun Nakazato  1 , Kazuhito Hirata  1 , Minoru Wake  1
Affiliations
Case Reports

Coronary spasm as the cause of myocardial ischaemia in a patient with anomalous origin of the left anterior descending artery from the proximal right coronary artery

Jun Nakazato et al. BMJ Case Rep. .

Abstract

A 49-year-old woman developed angina at rest. A CT of the coronary artery revealed that the left anterior descending artery arose from the right coronary artery, and traversed between the aorta and pulmonary trunk. An exercise stress myocardial scintigraphy did not reproduce myocardial ischaemia or anginal symptoms. A coronary angiography did not show any atherosclerotic changes. Finally, an ergotamine provocation test for vasospasm revealed diffuse severe spasm in the right coronary artery and the left anterior descending artery. Surgical correction of the anomaly was deferred and the patient was managed with medications to control spasm with good clinical outcome.

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Figures

Figure 1
Figure 1
The initial ECG showing ST depression in II, III, aVF leads in the emergency room.
Figure 2
Figure 2
A CT angiography of the heart showing the left anterior descending (LAD) artery arising from right coronary artery. Arrows indicate that LAD courses between the ascending aorta and the pulmonary trunk. Abbreviations: Left circumflex artery (LCX), left anterior descending (LAD), aorta (AO), pulmonary artery (PA), right coronary artery (RCA).
Figure 3
Figure 3
A stress myocardial scintigraphy did not show any evidence of myocardial ischaemia.
Figure 4
Figure 4
(A) Left anterior oblique view of the left anterior descending artery from right coronary artery. (B) An ergotamine provocation test for vasospasm revealed diffuse severe spasm in the right coronary artery and left anterior descending artery. (C) Coronary spasm was relieved with the administration of intracoronary nitroglycerin. Abbreviation: Left anterior descending (LAD)
Figure 5
Figure 5
The 12-lead ECG during ergotamine testing showing ST depression in II, III, aVF V5 and V6 leads.
See this image and copyright information in PMC

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