Open AccessCoronary artery spasm: An often overlooked diagnosis
Author(s) -
Oluwaseun Davies,
Olumide Ajayeoba,
Damian Kurian
Publication year - 2014
Publication title -
nigerian medical journal/nigerian medical journal
Language(s) - English
Resource type - Journals
eISSN - 2229-774X
pISSN - 0300-1652
DOI - 10.4103/0300-1652.137231
Subject(s) - medicine , cardiology , coronary vasospasm , vasospasm , asymptomatic , artery , chest pain , coronary artery disease , stenosis , percutaneous coronary intervention , sudden death , coronary arteries , sudden cardiac death , myocardial infarction , subarachnoid hemorrhage , angina
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.