title: Acute myocardial infarction caused by spontaneous coronary intramural hematoma.
abstract: A 49-year-old male presented to our emergency department with sudden anterior chest pain. His electrocardiogram revealed ST-segment elevations in leads II, III and aVF. An inferior acute myocardial infarction was suspected. Emergent coronary angiography (CAG) showed there was a long lesion in the right coronary artery (RCA), which continued from the proximal to the distal part of RCA with 50% stenosis and narrowed further to 99% stenosis at the distal end. Intravascular ultrasound (IVUS) examination demonstrated a diffuse intramural hematoma raging from the proximal to the distal part of the RCA. No visualization of the intimal flap was identified by IVUS, indicating coronary artery dissection as a pathogenesis of this hematoma formation. After intracoronary injection of isosorbide dinitrate, the 99% stenosis regressed to 50% spontaneously. Neither balloon angioplasty nor stenting was performed. He was discharged home free from symptoms 9 days after the procedure. Thirty-day follow-up CAG revealed an almost normal finding of the RCA and IVUS delineated a complete restoration of the intramural hematoma.
authors.affiliation: Department of Cardiology, Niigata City General Hospital, Shumoku 463-7, Chuo-ku, Niigata 950-1197, Japan. ryutaro.i.0820@gmail.com
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Ikegami
authors.forename: Keiichi
authors.initials: K
authors.lastname: Tsuchida
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Oda
mesh_terms: D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications* / Q000188:drug therapy; D004562:Electrocardiography; D006406:Hematoma / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007269:Injections, Intra-Arterial; D007548:Isosorbide Dinitrate / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D007548:Isosorbide Dinitrate