Case of nonobstructive coronary artery disease of left anterior descending artery (LAD) and regional LV dysfunction detected on cardiac CT with subsequent.

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Presentation transcript:

Case of nonobstructive coronary artery disease of left anterior descending artery (LAD) and regional LV dysfunction detected on cardiac CT with subsequent diagnosis of ACS. A 52-year-old man with no cardiovascular risk factors presented to the ED with exertional chest pain and admitted for a rule out myocardial initial negative troponin, and nonischemic ECG. Cardiac CT on admission showed nonobstructive coronary atherosclerotic plaque (noncalcified) in the LAD but with mid-distal anterior wall hypokinesis (Movie 1). Case of nonobstructive coronary artery disease of left anterior descending artery (LAD) and regional LV dysfunction detected on cardiac CT with subsequent diagnosis of ACS. A 52-year-old man with no cardiovascular risk factors presented to the ED with exertional chest pain and admitted for a rule out myocardial initial negative troponin, and nonischemic ECG. Cardiac CT on admission showed nonobstructive coronary atherosclerotic plaque (noncalcified) in the LAD but with mid-distal anterior wall hypokinesis (Movie 1). The following troponin drawn 6 hours later became positive. Invasive coronary angiography revealed proximal LAD with 30% stenosis that was partially improved with intracoronary nitroglycerin. The patient was discharged with a final diagnosis of ACS caused by coronary vasospasm. Curved multiplanar reformation CT image of the LAD (A) and invasive coronary angiography (B) showing mild nonobstructive coronary atherosclerosis. Midventricular short-axis and 2-chamber views obtained during end-systole (C and D) and end-diastole (E and F) demonstrating the anterior wall hypokinesis. Sujith K. Seneviratne et al. Circ Cardiovasc Imaging. 2010;3:375-383 Copyright © American Heart Association, Inc. All rights reserved.