Published online Aug 26, 2020. doi: 10.12998/wjcc.v8.i16.3601
Peer-review started: March 3, 2020
First decision: April 24, 2020
Revised: May 27, 2020
Accepted: July 16, 2020
Article in press: July 16, 2020
Published online: August 26, 2020
Processing time: 175 Days and 0.4 Hours
Coronary artery spasm is a major cause of myocardial ischemia. Although coronary artery spasm has been known for a long time, its mechanism has not yet been identified. Many clinicians, especially young clinicians pay less attention to coronary artery spasm, which may lead to some patients not being appropriately diagnosed and treated in time. We report a patient with spontaneous multivessel coronary artery spasm for more than 30 years diagnosed with intravascular ultrasound (IVUS) imaging.
A 66-year-old Chinese male patient had chest squeezing at rest for more than 30 years. He had a history of cigarette smoking for more than 40 years and hypertension for 10 years. Before presenting at our institution, the patient had undergone coronary angiography 4 times and percutaneous transluminal coronary angioplasty procedures twice at other hospitals without a diagnosis of coronary artery spasm. However, his chest symptoms worsened. Spontaneous multivessel coronary artery spasm occurred during IVUS without provocation testing, and the IVUS image was recorded. Thus, the diagnosis of multifocal spontaneous coronary artery spasm was confirmed. The patient was placed on oral diltiazem, isosorbide mononitrate, and nicorandil to suppress coronary artery spasms. All medications were given at the maximum dosages tolerated by the patient. He was discharged after 5 d without complications. During the six-month follow-up period, the patient was symptom-free.
Coronary artery spasm is still prevalent in Eastern countries. It is essential for clinicians to be aware of coronary artery spasm, which may be hard to detect and can be lethal, in order to diagnose and treat patients appropriately.
Core tip: Coronary artery spasm is an important cause of myocardial ischemia. Although coronary artery spasm has been known for a long time, its mechanisms have not yet been identified. Coronary artery spasm is prevalent in Asian countries, but many clinicians, especially young clinicians, pay less attention to coronary artery spasm, which may result in misdiagnosis and mistreatment. It is essential for clinicians to be aware of coronary artery spasm, which may be hard to detect but can be lethal, in order to diagnose and treat patients appropriately.