A 42-year-old
male presented to the
emergency department with acute
chest pain. The
electrocardiogram revealed
inferior wall myocardial infarction.
Emergency coronary angiography revealed total occlusion of the distal right
coronary artery with
thrombus.
Patient was taken up for primary percutaneous coronary
angioplasty with stenting of distal right
coronary artery. Six hours following the
procedure, the
patient developed re-elevation of ST-segment in inferior leads of
electrocardiogram and subsequent haemodynamic instability. Repeat
coronary angiography revealed patent
stent and
coronary artery spasm in proximal part, which was relieved by intracoronary
injection of nitroglycerine. After an hour, the
patient re-developed symptoms of
chest pain along with
bradycardia,
hypotension and ST segment elevation.
Intravenous infusion of nitroglycerine did not improve the condition but produced persistent
hypotension. Infusion of
milrinone was then started. Over
time, normalisation of
electrocardiogram occurred. The
patient was discharged in stable condition. This case suggests that
milrinone may be effective in alleviating
coronary artery spasm when the use of other agents fails.