Coronary spasm that caused non-ST elevation myocardial infarction appeared in cath lab due to vasovagal reaction

Area of Science:

• Cardiology
• Vascular Medicine
• Diagnostic Imaging

Background:

• Myocardial ischemia can result from dynamic, transient stenosis, not solely fixed coronary artery stenosis.
• Coronary artery spasm is an underrecognized cause of myocardial ischemia.
• Angiography shows vasculature at a single point in time; absence of stenosis does not exclude underlying disease.

Purpose of the Study:

• To present a case of right coronary artery spasm inducing non-ST elevation myocardial infarction and arrhythmias.
• To illustrate the potential for coronary artery spasm to be triggered by non-cardiac events, such as vasovagal reactions.

Main Methods:

• Case report detailing clinical presentation, diagnostic workup, and management.
• Coronary angiography to assess for stenosis and evaluate spasm provocation.
• Electrocardiographic monitoring to detect ischemia and arrhythmias.

Main Results:

• A patient experienced non-ST elevation myocardial infarction and arrhythmias attributed to right coronary artery spasm.
• Coronary artery spasm was re-induced in the cardiac catheterization laboratory during a vasovagal reaction.
• The findings underscore the dynamic nature of coronary artery stenosis.

Conclusions:

• Coronary artery spasm is a critical, often overlooked, cause of acute coronary syndromes.
• Transient vasospasm can precipitate significant cardiac events, emphasizing the need for considering dynamic stenosis in diagnosis.
• Vasovagal reactions can unmask or induce coronary artery spasm, highlighting a potential trigger mechanism.