ANGIOGRAPHICALLY DOCUMENTED CORONARY VASOSPASM AS A CAUSE OF MYOCARDIAL-INFARCTION DURING THE ACUTE-PHASE OF AORTIC DISSECTION

We angiographically documented coronary vasospasm which resulted in my ocardial infarction during the acute phase of aortic dissection (Stanf ord A). Coronary and aortic angiography performed at admission of the patient revealed complete occlusion of the right coronary artery and d issection of the aorta. Intracoronary injection of isosorbide dinitrat e and intravenous administration of verapamil opened the occluded righ t coronary artery and blood flow was fully restored. We conclude that, in this case of aortic dissection, the severe stimulation by the aort ic dissection brought about vasospasm of the right coronary artery whi ch was the major cause of myocardial infarction. This is the first cas e report showing clear evidence that myocardial infarction is brought about by vasospasm associated with aortic dissection.