Coronary vasospasm is defined as an exaggerated contractile response of the smooth muscle from the epicardial coronary artery. Its presentation is variable and may differ from asymptomatic to acute myocardial infarction (MI) or sudden death. This report is about a male patient, 56 years of age, who presented repeated events of acute coronary syndrome without ST-segment elevation. In November 2018, during his second event, the electrocardiogram showed intense ST-segment depression and T-wave inversion at precordial leads. Coronary angiography demonstrated nonobstructive coronary arteries and a Takotsubo-like apical ballooning as seen on left ventriculography. One month later, he was readmitted at the Emergency Department presenting acute chest pain characterizing a new episode of MI without ST-segment elevation. After heart team discussion about propaedeutics and diagnostic possibilities in the context of myocardial infarction with nonobstructive coronary arteries (MINOCA), a new coronary angiography was performed, which revealed severe vasospasm in the mid-segment of the left anterior descending artery, reverted after intracoronary nitroglycerin administration. Pharmacological therapy with calcium antagonist and nitrates was implemented, resulting in adequate clinical control. The patient presented no new episodes of angina or MI on followup. Challenging situations can be found in MINOCA, and a precise diagnosis can provide targeted treatment and reduce the risk of adverse outcomes.
Myocardial infarction; Coronary angiography; Coronary vasospasm