Myocardial infarction with normal coronary arteries

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In more then 10 years (June 1968 to December 1978), 39 patients with documented myocardial infarction and normal coronary arteries were seen at The Cleveland Clinic Foundation. The myocardial infarction was documented by electrocardiographic tracings showing a pattern of evolving myocardial infarction with pathological Q waves and/or ventriculography showing discrete segmental impairment of the myocardial contractility or segmental ventricular aneurysm. The age range was 19 to 69 years. Most patients were women (22 women and 17 men). One third of the patients had a positive family history for coronary artery disease (13 of 39). Ten of 22 women were using birth control pills for some period prior to myocardial infarction. One fourth of the patients had hypertension, hypercholesterolemia, and hypertriglyceridemia. Anterior transmural myocardial infarction was the most common pattern found in the electrocardiogram. Twenty-six or two thirds of the patients had either an anterior, an anteroapical scar or ventricular aneurysm by ventriculography. Twenty-eight patients had normal coronary arteriograms, 11 patients had barely perceptible and questionable minor irregularities of the wall in one or more coronary arteries. Eight patients underwent an ergonovine provocative test, seven showing no spasm, but one patient had evidence of coronary artery spasm. At the time of their first visit the majority of the patients had either typical or atypical angina. Other symptoms included dyspnea, syncope, and varieties of arrhythmias. Most patients had an atrial gallop on examination (24 of 39). Other less common physical findings included cardiac enlargement, systolic heart murmur, and ventricular gallop. . .



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