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Majority of cardiologists may perform the computed tomography coronary angiography (CTCAG) in diagnosing patients with rest angina in the clinic . If patients had no stenosis by CTCAG, cardiologist may administer the calcium channel blocker (CCB) as suspecting of coronary spastic angina (CSA). They may perform the percutaneous coronary intervention (PCI) in patients with rest angina and significant organic stenosis without further examination of coronary artery spasm. Recent cardiologists less than 40 years old may miss the strict diagnosis of chest pain or oppression in patients with rest angina and organic stenosis. Pharmacological spasm provocation tests are employed to diagnose the presence of coronary spasm in the cardiac catheterization laboratory-. However, recent cardiologists may have less opportunity to perform the pharmacological spasm provocation tests to diagnose the coronary artery spasm, because cardiologists had less chance of diagnostic and follow-up coronary arteriography due to the widespread of CTCAG. In this case report, typical CSA was shown who had been medicated as an atypical chest pain or ischemic heart disease in the neighborhood hospitals. This patient was super sensitive to acetylcholine (ACh) but not ergonovine (ER).

Is There No Problem with Diagnosis of Vasospastic Angina in the Clinic?