Is There No Problem with Diagnosis of Vasospastic Angina in the Clinic?

75-year-old female was admitted to our hospital from a distant region due to rest angina and syncope. She had been medicated as an atypical chest pain or ischemic heart disease for 20 years in the neighborhood hospitals. She complained of chest pain mainly at rest and sometimes had syncope. Although coronary arteriography including the ergonovine spasm provocation test was performed once time, she was not diagnosed as coronary spastic angina. After the internet search, she was admitted to our hospital to investigate her chest symptom and syncope. Pharmacological spasm provocation tests including acetylcholine or ergonovine provoked two vessel spasm. Her chest symptoms improved after the administration of another coronary vasodilator. If cardiologists had no solid technology about pharmacological spasm provocation tests, there are less cardiologists who are familiar with coronary spasm in the future especially even in Japan.