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To the Editor.—
In your Aug 12 issue (229:811, 1974), a case of transmural myocardial infarction without demonstrable coronary artery disease was described. Possible causes—coronary artery spasm, embolism, anatomic variation, and small vascular disease—were briefly discussed. It would seem more plausible that the first electrocardiographic finding of ventricular fibrillation was the causative factor, ie, that the arrhythmia was primary (perhaps from electrocution, as the patient was working under his house when he was stricken, where inadvertent contact with a high voltage is quite possible). The resultant lack of adequate coronary perfusion during ventricular fibrillation, and the direct myocardial trauma and possible coronary artery compression during external cardiac massage, could have resulted in myocardial infarction. The patient's subsequent normal cardiac catheterization and coronary angiography and exercise stress test confirm the adequacy of his coronary vasculature during an adequate rhythm. Of course, a combination of decreased perfusion in ventricular fibrillation and one
Cabeen W. Infarction Without Coronary Artery Disease. JAMA. 1974;230(5):669. doi:10.1001/jama.1974.03240050017007
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