Abstract
We describe a rare case of coronary spastic angina (CSA) causing myocardial stunning with reversible wall thinning and motion abnormality of the left ventricle (LV). A 70-year-old woman presented with sudden resting angina. A 12-lead electrocardiogram showed typical ST-T changes of acute myocardial infarction. Although left ventriculography revealed akinesis from the apex to the mid-anterior LV, urgent coronary angiography did not show an obstructed coronary artery. Cardiac magnetic resonance imaging (MRI) identified thinning of the anterior wall in the akinetic region, without any late gadolinium enhancement. Cardiac single photon emission computed tomography (SPECT), using 123iodine beta methyl-iodophenyl pentadecanoic acid (123I-BMIPP) and 201thallium (201Tl), showed a mismatch congruent with the akinetic region. An acetylcholine provocation test performed during hospitalization revealed multivessel coronary spasms in all 3 epicardial arteries. After initiation of treatment with coronary vasodilators, the wall thinning and motion abnormality gradually recovered to the normal range. In the present case, CSA caused myocardial stunning associated with reversible wall thinning and motion abnormality in the acute phase. CSA can occasionally lead to two conditions associated with LV wall abnormalities: myocardial infarction and stunning. Although the findings of the 2 conditions are similar in the acute phase, stunning can be differentiated from infarction using multiple imaging modalities. Cardiac MRI and SPECT are useful tools for determining whether the myocardium is infarcted or stunned.
