Coronary vasospasm can be a primary cause of acute myocardial infarction and recurrent unstable angina, which can be effectively managed with nitrates and calcium antagonists.
Highlights vasospasm as a reversible AMI cause; hypothesis-generating and leaves open need for prospective validation.
A 30 year old man had an acute anterolateral myocardial infarction following which he developed unstable angina requiring percutaneous transluminal coronary angioplasty. He subsequently developed further angina with recurrence of coronary artery lesions that were reversed by intracoronary nitrate. A diagnosis of prinzmetal (vasospastic) angina was made and this had been the apparent cause of his myocardial infarction. He was treated with a calcium antagonist and an oral long acting nitrate with resolution of symptoms. He remained well and symptom free, and was reviewed in the outpatient clinic six weeks after discharge without problems.
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Lip et al. (1998) studied this question.
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