Atheroma and Coronary Artery Spasm

A 47-year-old man, a heavy smoker, developed chest pain in the morning. A few minutes before arrival at our center, he collapsed in the taxi. Ventricular brillation (VF) was documented at the emergency room. After successful cardiopulmonary resuscitation (CPR), Electrocardiogram (ECG) showed inferior ST segment elevation (STE) so he was transferred to the cardiac catheterization laboratory. Coronary angiogram showed no significant lesion in the left main (LM), anterior descending (LAD) and circumflex (Cx) arteries. The dominant right coronary artery (RCA) had a severe vasospam (> 90% luminal diameter stenosis) in the proximal part (Figure-1A). After administration of intracoronary nitroglycerine (NTG) 300 mcg, the vasospasm disappeared (Figure 1B). The lumen of RCA was enlarged and the smooth border was suggestive of insignificant plaque burden. The inferior ST elevation pattern was also normalized without Q wave. He was pain free and discharged home on aspirin and calcium antagonist. He did well but later discontinued follow-up.