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A 70-year-old woman presented to our emergency department with sudden resting angina at 8 p.m. Although she had experienced similar episodes over the previous 2 years, she had not previously sought medical attention, as these episodes had not been severe. She was a non-smoker with a prior history of untreated hypertension. On admission, her blood pressure was high (systolic/diastolic blood pressure, 173/109 mmHg), but findings of physical examination were otherwise unremarkable. A 12lead electrocardiogram (ECG) showed ST-segment elevation in leads I, aVL, and V2–V6 and reciprocal ST-segment depression in leads II, III, and aVF (Fig. 1A). The symptoms were resolved with an intravenous injection of isosorbide dinitrate. A transthoracic echocardiogram demonstrated akinesis in the region from the apex to the mid-anterior left ventricle (LV). Urgent coronary angiography did not demonstrate an obstructed coronary artery (Fig. 2, upper images). However, left ventriculography (LVG) revealed akinesis in the same region as did the echocardiogram (Fig. 3). The patient’s blood samples showed slightly elevated levels of cardiac troponin T (50–100 ng/l; normal range, 0–50 ng/l), slightly elevated creatine kinase (CK, 202 IU/l; normal range, 30–150 IU/l; maximum CK during hospitalization, 269 IU/l), and increased heart-type fatty acid-binding protein (14.2 ng/ml; normal range, 0–6.2 ng/ml), but CK-MB remained within normal limits (15 IU/l; normal range, 0–25 IU/l; maximum CK-MB during hospitalization, 20 IU/l). To investigate the myocardial damage in detail, we performed cardiac magnetic resonance imaging (MRI) on hospitalization day 2. Although cardiac MRI showed anterior wall thinning, late gadolinium enhancement (LGE) was not detected (Fig. 4). We also examined the cardiac single photon emission computed tomography (SPECT) using 123iodine beta methyl-iodophenyl pentadecanoic acid (123I-BMIPP) and 201thallium (201Tl) on hospitalization day 5. The dual cardiac SPECT revealed a mismatch from the apex to the mid-anterior LV; 123I-BMIPP images showed that the defect was ischemic memory (Fig. 5). Thus, cardiac MRI and SPECT were able to differentiate between infarcted and stunned myocardium. Coronary Spastic Angina Causing Myocardial Stunning Associated with Reversible Wall Thinning and Motion Abnormality of the Left Ventricle: a Case Report

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Coronary Spastic Angina Causing Myocardial Stunning Associated with Reversible Wall Thinning and Motion Abnormality of the Left Ventricle: A Case Report