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A Case of Complete Atrioventricular Block Caused by Coronary Microvascular Vasospasm Kazuki Ito 1 , Hiroki Sugihara 2 , Kan Zen 1 , Takatou Hikosaka 1 , Yoshihiko Adachi 1 , Satoshi Yoneyama 1 , Shuuji Katoh 1 , Akihiro Azuma 2 1Department of Cardiology, Murakami Memorial Hospital, Asahi University 2Second Department of Medicine, Kyoto Prefectural University of Medicine Keyword: 冠微小血管 , 攣縮 , 造影遅延 , microvascular angina , spasm , delayed filling of contrast medium pp.629-633
Published Date 2000/6/15
DOI https://doi.org/10.11477/mf.1404902113
  • Abstract
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The patient was a 63-year-old woman who had an-gina chest pain at rest. An electrocardiogram (ECG)showed complete atrioventricular (AV) block and STsegment depression in II, III, aVF and V5-6leads. 99mTc-tetrofosmin myocardial SPECT showed reduced uptakein the inferior and posterior wall. Although left coro-nary arteriography findings were normal, right coronaryarteriography revealed severely delayed filling of con-trast medium without significant narrowing of epicar-dial coronary arteries, suggesting microembolism. Anintracoronary infusion of isosorbide dinitrate did notimprove the delayed filling of contrast medium or AVblock. Soon after an intracoronary infusion of nicoran-dil, coronary arterial flow was normalized, chest symp-toms disappeared, and ECG returned to normal sinus rhythm. Next day, 99mTc-tetrofosmin myocardialSPECT showed normal uptake. These findings suggestthat this rare phenomenon might be explained as havingbeen caused by microvascular spasm.


Copyright © 2000, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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