Severe spontaneous multiple coronary artery spasm during coronary angiography

Abstract

Acute coronary syndrome (ACS) is a critical disease especially in case of acute ST segment elevation myocardial infarction (STEMI). Acute STEMI typically shows ST segment elevation on electrocardiography (ECG), elevation of serum cardiac enzyme and abnormal regional wall motion on echocardiogram. However, coronary artery spasm (CAS), subarachnoid hemorrhage, pheochromocytoma, electroconvulsive treatment, and apical ballooning syndrome(superscript 1-3) can also result in similar clinical scenarios. Here, we report a case of a 65-year-old male who was admitted to our hospital because of severe chest pain associated with cold sweating and syncope. Coronary angiography (CAG) revealed spontaneous total occlusion of the left anterior descending artery (LAD) and right coronary artery (RCA) accompanied with severe chest pain, ST segment elevation, and hypotension. The severe coronary spasms were relieved via intracoronary administration of isosorbide dinitrate. After discharge, the patient was treated with verapamil, oral long-acting nitrate, and nicorandil. No chest pain with cold sweating or syncope occurred at OPD follow-up.