Spontaneous multivessel coronary artery spasm diagnosed with intravascular ultrasound imaging: A case report

Figure 1 Electrocardiographic findings in August 2017. A: Admission electrocardiography without symptoms; B: ST-segment elevation in II, III, aVF and V2-V5 leads during a chest squeezing episode in the early morning at 6:08; C: ST-segment depression in II, III and aVF, and ST-segment elevation in V2-V5 leads 83 s after the chest squeezing episode; D: ST segment depression in II, III and aVF, and ST-segment elevation in V2-V5 leads 3 min after the chest squeezing episode; and E: ST-segment elevation or depression disappeared 3 min and 25 s after sublingual administration of nitroglycerin.

Figure 2 Electrocardiographic findings in March 2019. A: Admission electrocardiography without symptoms; B: ST-segment elevation in I and aVL leads during a chest squeezing episode; C: ST segment elevation in I, aVL and V2-V3 leads during a chest squeezing episode; and D: ST segment elevation or depression disappeared accompanied by pain relief.

Figure 3 Initial coronary angiography before intravascular ultrasound. Mild atherosclerotic changes from the proximal to the mid segment in the right coronary artery. No obvious atherosclerotic changes in the left main trunk, left anterior descending and left circumflex coronary artery.

Figure 4 Coronary angiography during intravascular ultrasound. A: In the right coronary artery, a local coronary spasm occurred at the distal segment; and B: In the left coronary artery, a diffuse coronary spasm occurred at the proximal-distal segment of the left anterior descending coronary artery. The coronary spasm segments are indicated by arrows.

Figure 5 Coronary angiography after the intracoronary injection of nitroglycerin. The left anterior descending coronary artery spasm was relieved.

Figure 6 Intravascular ultrasound. Intravascular ultrasound images of the right coronary artery (A) and left anterior descending coronary artery (B) with increased media thickness.