[Rest angina caused by coronary spasm]

A 70-year-old woman with recurrent angina at rest and dyspnea was admitted for coronary angiography. Prior to the admission an ECG showed new negative T-waves in the precordial leads, which have completely disappeared the day after. Clinical examination revealed a low systolic murmur over the aortic valve and a low murmur over the left groin artery. The other examination findings were normal.

Exercise ECG revealed no signs of ischemia. In the coronary angiography a plaque in the left circumflex artery without significant lumen reduction could be detected. Intracoronary administration of acetylcholine induced a spasm in the left circumflex artery with total lumen occlusion with reproduction of intense chest pain. After injection of nitroglycerin coronary spasm and chest pain were reversible

After the diagnosis of vasospastic angina pectoris medical treatment with isosorbide dinitrate and amlodipine was initiated. Additionally ACE- and CSE-inhibitors were prescribed to improve endothelial dysfunction. After one year the patient was free of symptoms.

Coronary spasm can cause angina at rest. After confirmation of diagnosis an appropriate medical therapy could be applied and other unnecessary examinations including further coronary angiographies could be prevented.