Recurrent coronary spasm necessitating primary percutaneous coronary intervention

Abstract

Dr Ozan M Demir is ST3 Cardiology in the Department of Cardiology, Watford General Hospital, Hertfordshire WD12 0HG Dr Jonathan Hudson is F1 Cardiology in the Department of Cardiology, Watford General Hospital, Hertfordshire Dr Sarah Ghonim is ST3 Cardiology in the Department of Cardiology, Watford General Hospital, Hertfordshire Dr William Wallis is Consultant Cardiologist in the Department of Cardiology, Watford General Hospital, Hertfordshire Correspondence to: Dr OM Demir (ozanmdemir@gmail.com) occasions with chest pain caused by variant angina relieved by smooth muscle relaxants. However, she ultimately re-presented with ongoing chest pain and ST segment elevation myocardial infarction despite maximal medical therapy. Owing to refractory chest pain and worsening ST segments percutaneous coronary intervention with drug-eluting stents was performed. Subsequently her ST segment elevation resolved. Since stent implantation she has been asymptomatic for 8 months. This case highlights the recurrent course of coronary spasm and demonstrates the role of primary percutaneous intervention for the management of coronary spasm in life-threatening situations. Discussion Variant angina can be managed medically with a combination of calcium-channel blockers, nitrates and nicorandil, all acting to reduce smooth muscle contractility and prevent coronary artery spasm. Drugrefractory variant angina does not respond to treatment with two calcium antagonists plus a long-acting nitrate, and occurs in up to 30% of patients. Variant angina can be a life-threatening condition. Hung et al (2007, 2014) found that 3.2% of patients with coronary artery spasm will present with life-threatening complications, most commonly complete atrioventricular block and ventricular fibrillation. Given its lifethreatening nature, drug-refractory variant