title: Left main coronary artery spasm--a rare entity as a cause of myocardial infarction in a patient.
abstract: Coronary artery disease (CAD) remains the major cause of mortality and morbidity in the United States despite significant advances for the prevention and treatment of CAD. Coronary artery spasm causing demand-supply mismatch with coronary ischemia can mimic CAD, resulting in unnecessary interventions. Left main coronary artery spasm, in particular, is a rare entity with only a few cases described in the literature.
  
  
  METHODS
  A 49-year-old African-American female was evaluated at outpatient clinics for ongoing episodes of substernal chest pain which were then classified as atypical. Adenosine myocardial perfusion imaging study showed a small-size, mild-intensity, reversible ischemia in the anterior wall attributed to breast attenuation artifact. Medical management failed to relieve her chest pain and she was eventually referred for left heart catheterization. Angiography raised the suspicion of vasospasm and intracoronary nitroglycerin was injected, with resolution of the stenosis.
  
  
  CONCLUSIONS
  There are multiple risk factors associated with coronary spasm. Although medical management, ie, vasodilators are the treatment of choice, cases refractory to medical therapy have been treated with coronary stenting and even coronary artery bypass graft surgery with acceptable outcomes.
authors: Heart & Vascular Institute, Harper Hospital, 4160 John R, Suite 510, Detroit, MI 48201, USA.
authors: Fahad
authors: F
authors: Ali
authors: Haroon A
authors: HA
authors: Faraz
authors: Muhammad Umer
authors: MU
authors: Siddiqui
mesh_terms: D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D003331:Coronary Vessels / Q000187:drug effects / Q000503:physiopathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology*; D005996:Nitroglycerin / Q000008:administration & dosage; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin