scholarly journals A case report of myocardial infarction with non-obstructive coronary artery disease: Graves’ disease-induced coronary artery vasospasm

2020 ◽  
Vol 4 (4) ◽  
pp. 1-5
Author(s):  
Margo Klomp ◽  
Sarah E Siegelaar ◽  
Tim P van de Hoef ◽  
Marcel A M Beijk
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Thyroid Function ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Artery Spasm ◽  
Smooth Muscles ◽  
Young Female ◽  
Graves Disease ◽  
Rare Presentation ◽  
Coronary Artery Vasospasm

Abstract Background Coronary artery spasm can occur either in response to drugs or toxins. This response may result in hyper-reactivity of vascular smooth muscles or may occur spontaneously as a result of disorders in the coronary vasomotor tone. Hyperthyroidism is associated with coronary artery spasm. Case summary A 49-year-old female patient with a 2-day history of intermittent chest pain and electrocardiographic evidence of myocardial ischaemia was referred for emergency coronary angiography. This revealed severe right coronary artery (RCA) and left main (LM) coronary artery ostial vasospasm, both subsequently relieved with administration of multiple doses intracoronary nitroglycerine. Intravascular optical coherence tomography showed absence of atherosclerosis and no evidence of thrombus or dissection confirming the diagnosis of coronary artery vasospasm. Laboratory tests of the thyroid function were performed immediately after coronary angiography revealing Graves’ disease as the cause of vasospasm. Discussion Our case represents a rare presentation of Graves’ disease-induced RCA and LM coronary artery ostial vasospasm. In patients with coronary artery vasospasm thyroid function study should be mandatory, especially in young female patients.

scholarly journals SAT-462 Coronary Vasospasm-Induced Myocardial Infarction: An Uncommon Presentation of Thyrotoxicosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Basma Ataallah ◽  
Barjinder Buttar ◽  
Georgia Kulina ◽  
Alan Kaell
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Coronary Artery Spasm ◽  
Coronary Spasm ◽  
Coronary Vasospasm ◽  
Graves Disease ◽  
Normal Coronary Arteries ◽  
Coronary Artery Vasospasm

Abstract Background: Coronary artery vasospasm-induced myocardial infarction is a rare cardiac complication of untreated thyrotoxicosis. Diagnosis is difficult due to the transient and unpredictable occurrence of coronary spasm [1]. Clinical Case: A 47-year-old Hispanic female smoker presented with a one-week history of severe, intermittent substernal chest pain radiating to the left arm. The pain was associated with palpitations and shortness of breath. She was afebrile with a heart rate of 100, a blood pressure of 119/59, a fine tremor, and brisk reflexes. No lid lag or proptosis was appreciated. The thyroid was enlarged, non-tender, without palpable nodules. ECG showed T- Wave Inversions in leads V1-V2 and ST depressions in V4-V5. Chest pain was relieved by SL nitroglycerin. Lab results showed a peak Troponin of 0.20 (N < 0.06), TSH 0.01 mU/L (N > 0.45mU/L), free T4 5.54 (N < 1.46 ng/dl), total T3 4.50 pg/mL (N < 1.37 ng/mL), free T3 21.0 ng/mL (N < 4.4 pg/ml), TSI 3.61 IU/L (N < 0.55 IU/L), thyrotropin R Ab 7.47 IU/L (N < 1.75 IU/L) and thyroglobulin Ab 1.3 IU/ml (ULN < 0.9 IU/ml). Thyroid US showed a heterogeneous enlarged thyroid gland with increased vascularity. For her NSTEMI she was treated with a heparin drip, aspirin, clopidogrel, atorvastatin, propranolol, and isosorbide mononitrate. Methimazole was started to treat thyrotoxicosis. Cardiac catheterization revealed coronary vasospasm without evidence of valvular or coronary artery disease. Methimazole restored euthyroidism and she has not had recurrence of angina. Discussion: Rarely, hyperthyroidism can present with transient myocardial ischemia secondary to coronary artery vasospasm in patients with normal coronary arteries. The etiopathogenesis is unclear and may relate to a direct metabolic effect of excess thyroid hormone on the myocardium. In a Korean study evaluating chest pain in patients who underwent coronary angiography, the incidence of coronary vasospasm was 5%, occurring most frequently in women under 50 years of age with thyrotoxicosis [2]. Conclusion: Patients who present with angina and are thyrotoxic should be evaluated for vasospasm. Females under 50 years old with Graves’ disease are at highest risk. Treatment includes antithyroid medications along with nitroglycerin, and we can consider calcium channel blockers including diltiazem. Treatment of thyrotoxicosis eliminates recurrence of vasospasm [3]. References 1. Chudleigh RA, Davies JS: Grave’s thyrotoxicosis and coronary artery spasm. Postgrad Med J. 2007, 83(985):e1-e2. 2. Zheng W, Zhang YJ, Li SY, et al: Painless thyroiditis-induced acute myocardial infarction with normal coronary arteries. Am J Emerg Med. 2015, 33:5-10. 3. Marah N, Bryant K, Haq S, Khan M: Graves’ disease-induced coronary vasospasm. JACC: Cardiovascular Interventions. 2016, 9(23):2452-2453.

scholarly journals OCT Findings in MINOCA

2021 ◽  
Vol 10 (13) ◽  
pp. 2759
Author(s):  
Krzysztof Bryniarski ◽  
Pawel Gasior ◽  
Jacek Legutko ◽  
Dawid Makowicz ◽  
Anna Kedziora ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Imaging Modality ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Artery Spasm ◽  
Morphological Characteristics ◽  
Artery Dissection ◽  
Plaque Disruption ◽  
Artery Disease

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is a working diagnosis for patients presenting with acute myocardial infarction without obstructive coronary artery disease on coronary angiography. It is a heterogenous entity with a number of possible etiologies that can be determined through the use of appropriate diagnostic algorithms. Common causes of a MINOCA may include plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, and coronary thromboembolism. Optical coherence tomography (OCT) is an intravascular imaging modality which allows the differentiation of coronary tissue morphological characteristics including the identification of thin cap fibroatheroma and the differentiation between plaque rupture or erosion, due to its high resolution. In this narrative review we will discuss the role of OCT in patients presenting with MINOCA. In this group of patients OCT has been shown to reveal abnormal findings in almost half of the cases. Moreover, combining OCT with cardiac magnetic resonance (CMR) was shown to allow the identification of most of the underlying mechanisms of MINOCA. Hence, it is recommended that both OCT and CMR can be used in patients with a working diagnosis of MINOCA. Well-designed prospective studies are needed in order to gain a better understanding of this condition and to provide optimal management while reducing morbidity and mortality in that subset patients.

Abstract 342: Impact Of System And Physician Factors On The Diagnostic Yield Of Coronary Angiography In Stable Ischemic Heart Disease: A Population Based Study

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Harindra C Wijeysundera ◽  
Feng Qiu ◽  
Maria C Bennell ◽  
Madhu K Natarajan ◽  
Warren J Cantor ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Ischemic Heart Disease ◽  
Diagnostic Yield ◽  
Obstructive Coronary Artery Disease ◽  
Ischemic Heart ◽  
Patient Factors ◽  
Artery Disease

Background: Wide variation exists in the diagnostic yield of coronary angiography in stable ischemic heart disease (IHD). Previous work has primarily focused on patient factors for this variation. We sought to understand if system and physician factors, specifically hospital and physician type, as well as physician self-referral, have incremental impacts on the yield of coronary angiography, above and beyond that of patient factors alone. Methods: All patients who underwent a diagnostic coronary angiogram for possible stable IHD, at the 18 cardiac centers in Ontario, Canada were identified from October 1st, 2008 to September 30th, 2011. Obstructive coronary artery disease was defined as stenosis greater than 70% in the main coronary arteries or greater than 50% in the left main artery. Physicians were classified as either invasive or interventional. Hospitals were categorized into cath only, stand-alone PCI and full service centers. Multi-variable hierarchical logistic models were developed to identify system and physician level predictors of obstructive coronary artery disease, having adjusted for patient factors. Results: Our cohort consisted of 60,986 patients who underwent a diagnostic angiogram for possible stable IHD, of which 33,483 had obstructive coronary artery disease (54.9%), ranging from 41.0% to 70.2% across centers. Self-referral rates varied from 4.8% to 74.6%. Fewer self-referral patients (52.5%) had obstructive coronary artery disease compared to non-self-referral patients (56.5%), with an odds ratio (OR) of 0.89 (95% CI 0.85-0.93;p <0.001), after accounting for patient factors. Angiograms performed by interventional physicians had a higher likelihood of showing obstructive coronary artery disease (60.1% vs. 50.8%; OR 1.22; 95% CI 1.17-1.28; p<0.001). Fewer angiograms at cath only centers showed obstructive disease (45.0%) compared to full service centers (58.1%); this was of borderline significance (OR 0.59; 95% CI 0.34-1.00; p=0.05). Conclusion: Physician and system factors are important predictors of the diagnostic yield of coronary angiography in stable IHD, even after accounting for patient characteristics. Further study into the drivers of how these physician and system factors impact diagnostic yield is an important focus for quality improvement.

Glomerular filtration rate is related to severity of obstructive coronary artery disease in patients undergoing coronary angiography

2011 ◽  
Vol 44 (4) ◽  
pp. 1161-1168 ◽  
Author(s):  
Gholamreza Davoodi ◽  
Samira Mehrabi Pari ◽  
Mehrnaz Rezvanfard ◽  
Mahmood Sheikh Fathollahi ◽  
Manouchehr Amini ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Glomerular Filtration Rate ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Obstructive Coronary Artery Disease ◽  
Artery Disease
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