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Case Reports

Coronary Artery Spasm: A Rare But Important Cause of Postoperative Myocardial Infarction

^a Division of Cardiac Surgery, London Health Science Centre, London, Ontario, Canada
^b University of Heidelberg, Heidelberg, Germany

Accepted for publication February 29, 2008.

^_* Address correspondence to Dr Guo, Division of Cardiac Surgery, London Health Sciences Centre, 339 Windermere Rd, Suite B6 112, London, Ontario, N6A 5A5, Canada (Email: linrui.guo{at}lhsc.on.ca).

Myocardial infarction that is attributed to native coronary artery spasm in the early postoperative phase has rarely been documented. We report three cases of postoperative myocardial infarction secondary to angiographically demonstrated coronary spasm. Native coronary artery spasm is a rare, but important cause of postoperative ischemia and infarction. Suspicious electrocardiographic changes warrant consideration of transesophageal echocardiography to detect unexpected wall motion abnormalities. Established treatments include intravenous or intracoronary infusion of nitroglycerin and calcium channel antagonists, although several new therapeutic agents may also be beneficial. Prompt coronary angiography is the only definitive modality for early diagnosis and targeted treatment.