Vasotonic acute myocardial infarction: Experience with eight cases

Abstract

Eight patients (6 women, 2 men) who suffered acute myocardial infarction believed to be primarily due to excessive coronary arterial vascular tone were observed over a five-year period. Infarction was subendocardial in 4 and transmural in 4. It was preceded by unusually stressful situations in 5 patients. Coronary angiograms appeared normal in 5 patients and showed segmental spasm in 1, generalized spasm in 1, and spasm plus thrombus in 1. Ventricular function was normal in 4 patients, whereas 3 had segmental dysfunction, and 1 had ventricular aneurysm. Postinfarction angina continued in 3 patients and was controlled by nitrates and calcium channel blockers in all. It is concluded that severe coronary spasm may cause acute myocardial infarction. Severe stress, female sex, and excessive “outpouring” of endogenous catecholamines may predispose to this event.