Heart 1998;79:191-194 ( February )
Case studies
Myocardial infarction in young people with normal coronary
arteries
Department of Medicine, University of
Otago, 201 Great King Street, Dunedin, New Zealand
Correspondence to: Dr Williams email: michael.williams{at}stonebow.otago.ac.nz
Accepted for publication 20 August 1997
Myocardial infarction occurring in young people with
angiographically normal coronary arteries is well described but the
pathophysiology of this condition remains unknown. Coronary artery
spasm in association with thrombus formation and minimal atheromatous
disease or spontaneous coronary artery dissection are possible causes.
Two young men presented with severe chest pain after acute alcohol
intoxication and each sustained an extensive anterior myocardial
infarction. Investigations including intravascular ultrasound
showed no evidence of atherosclerotic coronary artery disease. Coronary
artery spasm associated with acute alcohol intoxication as well as a
prothrombotic state and endothelial damage related to cigarette smoking
may be mechanisms leading to acute myocardial infarction in these cases. Acute myocardial infarction occurs in young persons with normal
coronary arteries and the diagnosis should be considered in young
patients presenting with severe chest pain, particularly those abusing
cocaine or alcohol, so that reperfusion therapy can be initiated promptly.
© 1998 by Heart
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