LETTER TO THE EDITOR
Transient ischemia as a possible etiology for ventricular dysfunction
Victor J. Castro, MD, FACPa,
Cesar Larrauri, MDa and
Alfonso Bryce, MDa
a Cardiology Division, Department of Medicine, Cayetano Heredia University, Punta Negra 211, San Isidro, Lima, Peru
vcastro_1{at}hotmail.com
In the interesting study presented by Tsuchihashi et al. (1), we believe a few points deserve further discussion. Myocardial damage as evidenced by the finding of a positive creatinine kinase in 56% and the more sensitive troponin T in 72% of patients supports a possible role for myocardial ischemia, even if transient, as an important contributor in the pathogenesis of the ventricular dysfunction observed. Although coronary vasospasm was considered, only 55% of the patients were tested for it. Because of glagovian remodeling, coronary arteries may harbor significant amounts of arteriosclerotic plaque without obvious stenosis in angiography. These diseased but near normal looking coronary segments may develop marked spasm upon stimulation (2). Additionally, multiple drugs may induce vasospasm in normal coronary arteries. Clasically, cocaine use might trigger intense vasospasm (3) besides other adverse cardiac effects like acceleration of atherosclerosis or direct cardiotoxicity. Various commonly used drugs including antimigraine medications such as ergotamine or sumatriptan may also cause coronary vasospasm (4,5). Therefore, drug and toxicology testing during the acute episode to exclude exposure to these agents might have been rewarding. With the growing worldwide epidemic of substance abuse and self-medication, physicians will more frequently encounter adverse cardiovascular events in "low risk" populations. If not correctly diagnosed, unrecognized and/or recurrent use may lead to life-threatening complications.
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1. Tsuchihashi K, Ueshima K, Uchida T, et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. J Am Coll Cardiol. 2001;38:11–18[Abstract/Free Full Text]
2. Vincent GM, Anderson JL, Marshall HW. Coronary spasm producing coronary thrombosis and myocardial infarction. N Engl J Med. 1983;300:220–223
3. Minor RL, Scott BD, Brown DD, et al. Cocaine-induced myocardial infarction in patients with normal coronary arteries. Ann Intern Med. 1991;115:797–806[Abstract/Free Full Text]
4. Liston H, Bennett L, Usher B, et al. The association of the combination of sumatriptan and methisergide in myocardial infarction in a premenopausal woman. Arch Intern Med. 1999;159:511–513[Abstract/Free Full Text]
5. Mueller L, Gallagher RM, Ciervo CA. Vasospasm-induced myocardial infarction with sumatriptan. Headache. 1996;36:329–331[CrossRef][Medline]
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