Unexpected coronary vasospasm: a case of systemic minoxidil-induced angina pectoris

Minoxidil is a potent vasodilator primarily used for the treatment of severe hypertension, and androgenic alopecia.Although known adverse effects include fluid retention, tachycardia and hypertrichosis, its potential to induce coronary vasospasm remains largely underreported.[1] Minoxidil is currently reserved for treating alopecia for various causes.The ingestion of topical minoxidil, which is commonly available in 2% or 5% of a 60 mL solution, is reported to cause severe hypotension and refractory circulatory shock.[2] However, only a few clinical case reports highlight the features of angina secondary to systemic administration minoxidil (tablet).We present a case of a 37-year-old male who developed coronary vasospasm mimicking Prinzmetal angina (or variant angina) shortly after initiating oral minoxidil therapy for hair loss.This case emphasizes the importance of recognizing drug-induced vasospasm in the differential diagnosis of chest pain, particularly in patients with no significant coronary artery disease on imaging.A 37-year-old male with controlled hypertension, and no cardiovascular risk factors or prior history of coronary artery disease, presented to the Emergency Department with complaints of chest pain and precordial heaviness.The symptoms started three days after initiating oral minoxidil (2.5 mg twice daily), which was prescribed for androgenic alopecia.He typically described the pain as intermittent, even at rest, and more pronounced in the morning.The discomfort lasts for a few minutes at a time, without any obvious trigger.He denied shortness of breath, palpitations, diaphoresis, or syncope.Upon arrival, the patient had a blood pressure of 120/80 mmHg (1 mmHg=0.133kPa) and a heart rate of 76 beats per minute.Cardiovascular examination was normal, with normal S1 and S2, values and no murmurs,