Cold pressure test producing coronary spasm, coronary thrombosis and myocardial infarction in a patient with IgM antibodies against Coxsackie B virus.
Several lines of evidence have shown that viral infections are capable of causing coronary spasm and precipitating or mimicking clinical myocardial infarction. Here we report the case of a 41-year-old woman with recurrent angina who was admitted to our hospital because of ventricular tachycardia. Laboratory examination revealed positive IgM titers against Coxsackie B virus. Coronary angiography showed normal coronary arteries, but following a cold pressure test severe spasm of all coronaries with thrombotic occlusion of the second marginal branch of the circumflex artery occurred. We conclude that coronary spasm should be clinically suspected in patients with chest pain and ventricular arrhythmia in combination with IgM antibodies against Coxsackie B virus. In these patients, a cold pressure test should be avoided, and antithrombotic and antispastic therapy is recommended.
Haberbosch
W
W
Department of Cardiology, Justus Liebig University Giessen, Germany. werner.g.haberbosch@innere.med.uni-giessen.de
Roerich
N
N
Neuzner
J
J
D000328:Adult; D000787:Angina Pectoris / Q000175:diagnosis / Q000628:therapy / Q000821:virology; D015906:Angioplasty, Balloon, Coronary; D000914:Antibodies, Viral / Q000032:analysis*; D000998:Antiviral Agents / Q000008:administration & dosage; D003080:Cold Temperature / Q000009:adverse effects*; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000175:diagnosis* / Q000628:therapy / Q000821:virology; D003384:Coxsackievirus Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D004562:Electrocardiography; D029822:Enterovirus B, Human / Q000302:isolation & purification*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood*; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy / Q000821:virology; D016896:Treatment Outcome
D000914:Antibodies, Viral; D000998:Antiviral Agents; D007075:Immunoglobulin M