Coronary artery spasm: An often overlooked diagnosis

Abstract

Coronary vasospasm can lead to myocardial injury and even sudden cardiac death. It has generally been overlooked as a diagnosis since atherosclerosis is a more common cause of acute coronary syndromes and because of the dilemma involved in its diagnosis. A middle-aged man with a history of smoking and cocaine use presented to the emergency department with left-sided arm/chest discomfort and diaphoresis. The electrocardiogram showed anterior ST elevation and hyper-acute T waves, which completely resolved shortly after sublingual nitroglycerin was administered. Subsequent angiogram revealed a 70% focal stenosis in the mid-left anterior descending artery. Coronary vasospasm occurs more commonly in arteries with underlying atheromatous disease, although normal vessels are not excluded. Cigarette smoking and cocaine use are among the major culprits that have been implicated as risk factors for the occurrence of coronary vasospasm. Eventually, the patient had percutaneous coronary intervention of his left-anterior descending artery and remained asymptomatic.

Keywords: Angina; coronary; prinzmental; vasospasm.

Figure 1

EKG showing Leads V1-V6 in the patient. The EKG was taken at the onset of chest pain in the emergency department and it shows marked ST elevation and hyper-acute T waves in V2, V3, and V4

Figure 2

EKG showing Leads V1-V6 in the patient. The EKG was done 35 minutes after the previous EKG, shown in Fig. 1 (this was about 20 minutes after the 1st of the 2 doses of sublingual nitroglycerin given) and it shows resolution of initial EKG changes

Figure 3

Coronary arteriogram showing area of 70% occlusion (arrow pointing towards the area)