Silent coronary spastic angina: A report of a case

A 54-year-old man was admitted to our hospital due to abnormal electrocardiogram (ECG) changes. He had experienced no chest pain or chest discomfort during daily life until then. Ischemic ECG change was obtained by the treadmill exercise test but he complained of no chest pain or chest oppression. We performed coronary angiography and found near normal coronary artery with hypoplasty of right coronary artery. He complained of no chest symptoms irrespective of ischemic ECG change [ST depression in V3-6 leads (2.0-3.0 mm)], when intracoronary injection of 50 μg acetylcholine provoked subtotal spasm at mid left anterior descending artery and focal spasm at proximal left circumflex artery. After the administration of calcium-channel antagonist for four months, ischemic ECG changes were improved by the treadmill exercise test. He had experienced some slight fatigue during daily life and cold sweating during sleep three or four times a month before the medication. However, he had experienced less slight fatigue and no cold sweating during sleep after taking the calcium-channel antagonist. He experienced silent coronary spastic angina. <Learning objective: We describe a case of coronary spastic angina without any chest symptoms through their life and discuss silent/painless coronary spastic angina.>.