A 68 year old woman with symptoms and signs suspicious of aortic stenosis was admitted for invasive assessment with left and right heart catheterisation after echocardiographic examination had indicated aortic valve stenosis. The subsequent angiography revealed a very rare course of the “vena cava” which made a large loop superior to the right atrium before it eventually ended in the right atrium. Due to the very unusually anatomy a CT scan of the great vessels with subsequent 3D reconstruction was performed. This combination of a rudimentary inferior vena cava connecting the liver to the right atrium, absence of a proper inferior caval vein and a voluminous azygos forming a large loop before ending up in the right atrium is very rare.
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Typical triggers of coronary artery spasm are pharmacological drugs, coronary interventions or application of cocaine. This case report describes two cases of metamizol induced coronary spasm. In the first case, a 40 years old female presented with ST elevation in V2-V5 after treatment with metamizol. Angiography showed a coronary spasm in the right coronary artery. In the second case, a 42 years old male had to be resuscitated by ventricular fibrillation after treatment with metamizol. In the cathlab a distinct coronary spasm of the left anterior coronary artery was found. Both spasms were effective terminated with intracoronary application of nitrates. Coronary spasm is a possible adverse reaction of metamizol.
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