Coronary Artery Spasm

Case presentation: A 37-year-old man was admitted in the early morning hours to the emergency department after experiencing excruciating chest pain. The patient was a heavy smoker who gave a history of several previous similar but less intense episodes of pain during the past 2 years; most of them also during the early morning hours. One of his earlier attacks was associated with sensing his heart “bouncing.” In addition, he had experienced several episodes of “palpitations” without pain. On admission, ECG showed a 2 to 3 mm ST elevation which returned to baseline quickly, concomitant with his pain subsiding. Cardiac biomarkers were normal but C-reactive protein was elevated. Twenty-four hours later, a treadmill test showed good exercise capacity and no ST changes even at target heart rate. The clinical and ECG pictures pointed to the diagnosis of a vasospastic-type Printzmetal angina, and the patient responded well to calcium blockers and long-term nitroglycerin therapy and remained symptom-free throughout a 2-year follow-up.