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Year : 2014  |  Volume : 55  |  Issue : 4  |  Page : 356-358

Coronary artery spasm: An often overlooked diagnosis

1 Department of Internal Medicine, Columbia University at Harlem Hospital Center, New York, USA
2 Department of Cardiology, Columbia University at Harlem Hospital Center, New York, USA

Correspondence Address:
Oluwaseun Davies
Department of Internal Medicine, Columbia University at Harlem Hospital Center, 506 Lenox Avenue, MLK 14-106, New York 10037
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0300-1652.137231

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Coronary vasospasm can lead to myocardial injury and even sudden cardiac death. It has generally been overlooked as a diagnosis since atherosclerosis is a more common cause of acute coronary syndromes and because of the dilemma involved in its diagnosis. A middle-aged man with a history of smoking and cocaine use presented to the emergency department with left-sided arm/chest discomfort and diaphoresis. The electrocardiogram showed anterior ST elevation and hyper-acute T waves, which completely resolved shortly after sublingual nitroglycerin was administered. Subsequent angiogram revealed a 70% focal stenosis in the mid-left anterior descending artery. Coronary vasospasm occurs more commonly in arteries with underlying atheromatous disease, although normal vessels are not excluded. Cigarette smoking and cocaine use are among the major culprits that have been implicated as risk factors for the occurrence of coronary vasospasm. Eventually, the patient had percutaneous coronary intervention of his left-anterior descending artery and remained asymptomatic.

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