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We report on a case of multivessel coronary artery spasm preceded by vagal signs and symptoms, which resolved after administration of atropine. This supports that the spasm was triggered by endogenous acetylcholine.

We report on a case of significant exertional symptoms secondary to occlusion of a nondominant right coronary artery proximal to the sino-atrial branch, with associated exercise-induced sinus node dysfunction. Successful angioplasty of the occluded right coronary artery restored a normal functional capacity and sinus tachycardia response to exercise.

We report on a case of a pericardial drainage catheter that severed on attempted removal. Surgery was required to remove the retained portion. No manufacturing defects were found on analysis of the catheter. Shear forces due to heart movement and the angle of catheter entry into the pericardium were the suspected reasons for the catheter disruption.

We describe the first reported case of an internal mammary artery originating from the junction of the left subclavian artery and aorta. Noting this, along with other reported anomalies and various pathologic conditions, it appears warranted to perform routine preoperative internal mammary artery angiography before coronary artery bypass surgery.

This report describes successful results from intracoronary streptokinase administered beginning 6 hr after onset of symptoms to a 32-year-old male with subtotal vessel occlusion by thrombus. Coronary angiography 26 days later demonstrated normal vessels. We conclude that 1) duration of symptoms beyond 3-4 hr should not preclude the use of thrombolytic therapy in evolving myocardial infarction, 2) this patient exemplifies the higher incidence of subsequently demonstrated normal coronary arteries in patients under age 35 with acute myocardial infarction; arterial spasm and platelet aggregation are the most likely causes of coronary occlusion in these patients.