[Spasm, stenosis and thrombosis. Their role in the genesis of myocardial infarction].
A 42 year old patient underwent coronary angiography 3 hours after the onset of inferior myocardial infarction with the object of local thrombolysis therapy. Complete proximal obstruction of the right coronary artery was relieved mechanically by the catheter. This was associated with a return of the ST segment to the isoelectric line but Q waves persisted in Lead III and AVF. A second injection showed 70 p. 100 stenosis at the site of the obstruction and the radiolucent appearances of thrombus below it. This was followed by 4 successive periods of ST elevation as the right coronary artery reoccluded. These phenomena were relieved by injection of nitroglycerine suggesting a spastic mechanism. The radiolucent image of thrombus disappeared and was replaced by amputation of a distal branch of the right coronary artery. Further coronary opacification showed good run-off beyond the stenosis and reappearance of the distal branch. This case suggests that three factors played a role in the mechanism of infarction: stenosis accompanied by spasm and thrombosis.
D000328:Adult; D001157:Arterial Occlusive Diseases / Q000503:physiopathology; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003329:Coronary Vasospasm / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004562:Electrocardiography; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000503:physiopathology*
Spasme, sténose et thrombose. Leur rôle dans la genèse d'un infarctus du myocarde.