Identification of Coronary Vasospasm as a Cause of Recurrent Acute Coronary Syndrome

J INVASIVE CARDIOL 2018;30(10):E100.

Key words: cardiac imaging, coronary arteriography, optical coherence tomography

Coronary artery disease in people without atherosclerotic risk factors and a healthy lifestyle is rare. We report a 52-year-old male who was admitted to our clinic due to recurrent angina pain for 3 days. Despite the absence of risk factors for cardiovascular disease and adherence to a very healthy lifestyle (non-smoker, no obesity, regular physical activity, and a healthy diet) he had undergone multiple stent implantations to the left anterior descending and left main coronary arteries.

Electrocardiogram, echocardiogram, and hs-troponin test showed no signs of ischemia. Coronary arteriography revealed a tight stenosis of the mid left anterior descending coronary artery between two previously implanted stents (Figure 1A) and we decided to treat the stenosis with percutaneous coronary intervention. The patient was given 0.2 mg nitroglycerin intraarterially due to spasm of the right radial artery. On subsequent coronary angiograms, the stenosis completely disappeared (Figure 1B). Optical coherence tomography demonstrated a healthy vessel at the site of spasm (Figure 1C). Therefore, the diagnosis of coronary artery vasospasm was made, and no percutaneous coronary intervention was performed. The beta-blocker was withdrawn, and the patient was started on a calcium-channel blocker. 

This case highlights the importance of nitrate administration, as routinely performed during coronary arteriography.

From the Heart Center Leipzig – University Hospital, Department of Cardiology Leipzig, Germany.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted August 29, 2018. 

Address for correspondence: Nicolas Majunke, MD, Heart Center Leipzig – University Hospital, Struempellstrasse 39, 04289 Leipzig, Germany. Email: nicolas.majunke@medizin.uni-leipzig.de