Key result
Intracoronary nitroglycerin and oral therapy resolve diffuse multivessel coronary spasm over 5 months in one patient.
Why the study?
Diffuse multivessel coronary artery spasm is rare, difficult to diagnose clinically due to its brief nature, and often occurs as complications.
Case Report (n=1)
This case highlights a rare presentation of diffuse multivessel coronary artery spasm induced by Valsalva maneuver, successfully managed with intracoronary nitroglycerin and oral medical therapy.
Valsalva may trigger diffuse multivessel spasm; single case leaves open incidence, mechanisms, and management implications.
RATIONALE: Diffuse multivessel coronary artery spasm (DMV-CAS) was defined as a severe and reversible diffuse spasm occurring in more than 2 major coronary arteries, which is rare in clinical practice. Due to a wide lesion scope, DMV-CAS often occurs in the form of complications. It is not easy to be clinically diagnosed because it is too brief to be caught. Here, we report a rare case of spontaneous subtotal occlusion of 3 major coronary arteries induced by Vasalva action, which was confirmed in real-time by CAG. PATIENT CONCERNS: A 68-year-old man had sudden chest pain after forced defecation during hospitalization. The electrocardiogram showed transient ST segment elevation of the inferior wall lead, inversion of the anterior wall, and lateral wall leads T waves. Emergency CAG revealed elongated vessel beds in 3 coronary arteries and multiple diffuse stenosis, but none of the coronary arteries were completely occlusive. DIAGNOSES: Diagnoses of DMV-CAS were made based on CAG findings and postmedication response. INTERVENTIONS: Nitroglycerin was administered in the coronary arteries. The anti-vasospasm, antiplatelet aggregation and lipid-regulating drugs were administered orally. OUTCOMES: The patient was discharged on the 7th day with complete resolution of symptoms and normalization of the electrocardiography findings. No ischemic events occurred during a follow-up for 5 months. LESSONS: This case highlights the identification of multivessel diffuse coronary spasm and acute myocardial infarction, and the prevention of CAS triggers, which requires the attention of clinicians.
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Cai et al. (2024) conducted a case report in Diffuse multivessel coronary artery spasm (DMV-CAS) (n=1). Intracoronary nitroglycerin and oral anti-vasospasm, antiplatelet, and lipid-regulating drugs was evaluated on Resolution of symptoms, normalization of ECG, and ischemic events. Intracoronary nitroglycerin and oral medical therapy led to complete resolution of symptoms and no ischemic events over 5 months in a 68-year-old man with diffuse multivessel coronary artery spasm.
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