Focal Interest
Focal Interest
AI Summary of Peer-Reviewed Research

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Left anterior descending artery spasm caused a large anterior myocardial infarction

A woman in professional attire operates a cardiac imaging workstation in a hospital setting, with a medical monitor displaying cardiovascular data on the left and diagnostic equipment visible in the background.
Research area:CardiologyCardiac Imaging and DiagnosticsCoronary Interventions and Diagnostics

What the study found

Isolated spasm of the left anterior descending artery (LAD) caused a large anterior myocardial infarction in a patient whose coronary arteries looked non-obstructive on angiography. The case shows that coronary artery spasm can be an under-recognized cause of myocardial infarction within the MINOCA spectrum, meaning myocardial infarction with non-obstructive coronary arteries.

Why the authors say this matters

The authors say this matters because diagnosis often requires testing beyond a non-obstructive angiogram. They state that early cardiac magnetic resonance imaging (CMRI) can localize infarction and help focus the workup, while intravascular imaging and coronary function testing can define the mechanism and guide therapy.

What the researchers tested

The report describes a 48-year-old woman with angina, dyspnea, hypotension, elevated troponin, anterior T-wave inversion on ECG, and severe regional wall-motion abnormalities on echocardiography. Angiography showed non-obstructive coronary arteries, then CMRI was used on day 2 and optical coherence tomography (OCT), an intravascular imaging method, was performed on day 3.

What worked and what didn't

CMRI localized a large acute anterior myocardial infarction in the LAD territory and helped narrow the evaluation. OCT showed LAD spasm and excluded plaque rupture, erosion, thrombus, and spontaneous coronary artery dissection (SCAD), supporting epicardial spasm as the mechanism and the final diagnosis of acute anterior wall MI due to isolated LAD spasm. Treatment was limited by vasospasm and hypotension; the report says therapy focused on calcium channel blockade, nitrates, and ivabradine, with cautious initiation of anti-remodeling agents.

What to keep in mind

This is a single case report, so the findings describe one patient rather than a broader group. The abstract does not provide long-term follow-up or comparative data, and it does not describe additional limitations beyond the constraints of this case.

Key points

  • A woman with non-obstructive coronary arteries had a large anterior myocardial infarction caused by isolated LAD spasm.
  • The case is presented as part of the MINOCA spectrum, which means myocardial infarction with non-obstructive coronary arteries.
  • CMRI localized the infarction to the LAD territory and helped focus the diagnostic workup.
  • OCT showed LAD spasm and excluded plaque rupture, erosion, thrombus, and SCAD.
  • Treatment was constrained by vasospasm and hypotension and included calcium channel blockade, nitrates, and ivabradine.

Disclosure

Research title:
Left anterior descending artery spasm caused a large anterior myocardial infarction
Authors:
Lior Shoev, Dan Haberman, Gera Gandelman, Jacob George, Natalia Kofman
Institutions:
Hebrew University of Jerusalem, Kaplan Medical Center
Publication date:
2026-02-26
DOI:
10.1016/j.crmic.2026.100146
OpenAlex record:
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AI provenance: This post was generated by OpenAI. The original authors did not write or review this post.

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