Coronary Spasm as a Cause of Recurrent Chest Pain: A Case Report

Background: Coronary artery spasm plays an important role in the pathogenesis of a wide variety of ischemic heart diseases, including myocardial infarction and sudden cardiac death. However, the diagnosis of vasospastic angina is not always easy on the basis of symptoms alone.

Case Presentation: A 36 year- old- man was evaluated due to recurrent left sided chest pain of 8 months duration. He is a smoker, and otherwise physical examination was unremarkable. Electrocardiogram and blood tests were normal, apart from elevated serum concentrations of triglycerides and low density lipoprotein cholesterol. During the recovery phase of exercise treadmill test, the patient developed progressive ST-segment elevation at inferior leads II, III and aVF together with progressive ST-segment depression at precordial leads V1 to V5. The ECG showed gradually decreased heart rate with the development of sinus bradycardia that progressed rapidly to complete heart block. The patient collapsed with chest pain and hypotension. It took about 10 minutes for the ECG retuning to the baseline after medical management. The patient was referred to the coronary care unit for further management and underwent coronary angiogram. Coronary spasm was observed in the proximal segment of the right coronary artery. The patient received medical treatment after coronary angiogram and stood well for more than one year follow up.

Conclusion: Coronary spasm may lead to both recurrent chest pain and significant arrhythmia and the diagnosis often requires high index of suspicion and lab documentation.