Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Feb 16;5(2):ytab015.
doi: 10.1093/ehjcr/ytab015. eCollection 2021 Feb.

The role of computed tomography coronary angiography in multi-vessel coronary vasospasm: a case report

James S Tomlinson  1 , Amit Patel  1 , Terry Levy  1
Affiliations
Case Reports

The role of computed tomography coronary angiography in multi-vessel coronary vasospasm: a case report

James S Tomlinson et al. Eur Heart J Case Rep. .

Abstract

Background: Coronary vasospasm can present like an acute coronary syndrome (ACS) with an intense vasoconstriction resulting in total or near-total occlusion of one or more of the coronary vessels. Definitive diagnosis can be made by intracoronary provocation testing.

Case summary: A 37-year-old Caucasian male and smoker was admitted with chest pain. Highly sensitive troponin-I was positive at 63 ng/L (99th percentile upper reference limit, <15 ng/L) with a repeat value of 45 ng/L three and a half hours later which was of clinical significance. Serial electrocardiography (ECG) showed no ischaemic changes. Coronary angiography revealed several distal and side branch stenoses; however, angiographic appearances were atypical of coronary plaque. A differential diagnosis of spontaneous coronary artery dissection was suspected although the patient was pain free during the procedure. Computed tomography coronary angiography (CTCA) demonstrated normal coronary arteries, confirmed on repeat invasive coronary angiography. Cold pressor testing was unsuccessful in reproducing vasospasm. Acute coronary syndrome treatment was discontinued, he received smoking cessation advice and Amlodipine 5 mg daily was started. He has experienced no further episodes of cardiac chest pain on follow-up consultation 7 months later.

Discussion: This is an unusual case of persistent, extensive coronary vasospasm in a patient without ongoing chest pain or ischaemic ECG changes. Intracoronary nitrates are usually effective at relieving coronary spasm. Cold pressor testing has poor sensitivity for diagnosing vasospasm when compared to intracoronary provocation testing using either acetylcholine or ergonovine. Multi-slice CTCA may help to discriminate coronary plaque from coronary vasospasm when there is diagnostic uncertainty.

Keywords: Acute coronary syndrome; Case report; Computed tomography angiography; Coronary angiography; Coronary vasospasm; Multislice computed tomography; Spontaneous coronary artery dissection.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Electrocardiography on admission showing no ischaemic changes.
Figure 2
Figure 2
(A, B) Severe multi-vessel stenosis (indicated by red arrows) seen on invasive coronary angiography.
Figure 3
Figure 3
(A–C) Three-dimensional reconstruction using computed tomography coronary angiography showing normal coronary arteries.
None
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Mishra PK. Variations in presentation and various options in management of variant angina. Eur J Cardio-Thorac Surg 2006;29:748–759. - PubMed
    1. Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N.. Angina pectoris I. A variant form of angina pectoris. Am J Med 1959;27:375–388. - PubMed
    1. Oliva PB, Potts DE, Pluss RG.. Coronary arterial spasm in prinzmetal angina. N Engl J Med 1973;288:745–751. - PubMed
    1. Kusama Y, Kodani E, Nakagomi A, Otsuka T, Atarashi H, Kishida H. et al. Variant angina and coronary artery spasm: the clinical spectrum, pathophysiology, and management. J Nippon Med Sch 2011;78:4–12. - PubMed
    1. Maseri A, Severi S, Nes M. D, L'Abbate A, Chierchia S, Marzilli M. et al. “Variant” angina: one aspect of a continuous spectrum of vasospastic myocardial ischaemia. Am J Cardiol 1978;42:1019–1035. - PubMed

Publication types

LinkOut - more resources