Coronary Artery Spasm
A 50-year-old male patient presented with severe chest pain and right arm tightness. On arrival, he was hypotensive and had an initial slow atrial fibrillation with acute ST-segment elevation across the anterior and inferior leads (Figure 1). This required external pacing as well as atropine. The patient underwent urgent diagnostic coronary angiography that revealed a severely diseased, small-caliber right coronary artery with 100% distal cutoff before its bifurcation (Figure 2); 25% distal left main coronary artery stenosis with a diffusely diseased left anterior descending coronary artery from the ostium to the apex; and a circumflex artery with 50% proximal stenosis (Figure 3). Intracoronary nitroglycerin and nicardipine were injected, which resulted in complete resolution of stenosis (Figure 4 and Figure 5). The ST-segment elevation on the ECG subsequently resolved, and the patient returned to sinus rhythm. The patient had a peak troponin value of 0.29 and preserved left ventricular function with no wall motion abnormalities.