ISCHEMIC-HEART-DISEASE SHOWING UNUSUAL ANGIOGRAPHIC FINDINGS

Atherosclerotic lesions usually occur in the proximal and middle porti on of the coronary arteries. Multiple obstructive lesions appearing on ly in the peripheral branches without lesions in the proximal or dista l portion have not been reported. We encountered a patient with ischem ic heart disease showing multiple obstruction in the peripheral branch es of the right and left coronary arteries without significant stenoti c lesions in the proximal or middle portion. This 49-year-old male was admitted to Yamada Red Cross Hospital due to angina pectoris. Coronar y risk factors for him included hypertension, abnormal glucose toleran ce, smoking habit, and obesity. Laboratory studies showed a complete b lood count and normal blood chemistries, as well as thromboplastin and prothrombin times. Coronary angiography showed multiple obstruction o r marked stenosis in the distal portion and peripheral branches; there was no stenosis in the proximal and middle portions. Left ventriculog raphy showed severe hypokinesis in the diaphragmatic segment. Biopsy o f the left ventricular endocardium showed interstitial fibrosis but sh owed no abnormalities in the myocardial fibers or cell infiltration to perivascular areas and vascular walls. Coronary angiography after two months showed multiple lesions, as previously observed. Although isch emic heart disease is caused by various types of vasculitis, embolism, coronary spasm, and fibromuscular dysplasia, in this patient, there w ere no findings suggestive of causes other than atherosclerosis. This case is interesting in terms of rare angiographic findings and its cau se.