An Extreme Case of Vasospastic Angina Mimicking Acute STEMI: Severe 3-Vessel Disease with Critical Stenos

Acute coronary syndromes generally result from the atherosclerotic plaque rupture or chronic stenosis. However, they may also be caused by vasospasm resulting from vasoactive peptides released from the endothelium around the plaques. The frequency of coronary vasospasm or variant angina may actually be higher than originally thought. Variant angina is a clinical condition that generally occurs after a triggering event and resolves spontaneously or after nitrate treatment, usually within 5 minutes. Clinical manifestations have also been reported to occur after coronary spasm due to a transient increase in the arterial tonus on the background of coronary plaques (1, 2). The male-to-female ratio is 5 to 1 (3). A normal electrocardiogram (ECG) recorded during chest pain may obscure a three-vessel vasospasm. Multi-vessel spasms are known to increase the risk of death, and therefore, angiography or provocative tests have been recommended (4, 5). An early and correct diagnosis may allow proper management with medications.