Recurrent acute coronary syndrome due to coronary artery spasm in different coronary arteries
Saman Rasoul1, Jan-Henk E Dambrink1
1Isala Klinieken, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands.
Insights
Isolated hypocalcemia can trigger coronary artery spasm (CAS), mimicking heart attacks in healthy individuals. This case highlights an unusual cause of recurrent acute coronary syndrome in a young woman, emphasizing the need for calcium level assessment.
Area of Science:
- Cardiology
- Internal Medicine
- Endocrinology
Background:
- Coronary artery spasm (CAS) is implicated in various ischemic heart diseases.
- Hypocalcemia-induced CAS can mimic myocardial infarction, but often with coexisting risk factors.
- Previous reports lack cases of isolated hypocalcemia causing CAS in healthy individuals.
Purpose of the Study:
- To report a case of recurrent acute coronary syndrome (ACS) caused by isolated hypocalcemia-induced coronary artery spasm.
- To highlight an unusual etiology of ACS in a young, healthy female with no traditional cardiac risk factors.
Main Methods:
- Clinical case presentation and review of relevant literature.
- Diagnostic workup included assessment of electrolyte levels and coronary angiography.
- Treatment response to calcium supplementation and medical management was evaluated.
Main Results:
- The patient experienced recurrent ACS attributed to coronary artery spasms.
- Laboratory findings revealed isolated hypocalcemia as the sole identifiable cause.
- Coronary artery spasms occurred in all three major coronary arteries, resolving with medical treatment.
Conclusions:
- Isolated hypocalcemia can precipitate coronary artery spasm and recurrent ACS.
- This case underscores the importance of considering electrolyte abnormalities, particularly hypocalcemia, in the differential diagnosis of ACS, even in young, healthy patients.
- Medical management is typically effective, but mechanical revascularization may be considered for refractory vasospasm.
Abstract:
Coronary artery spasm (CAS) plays an important role in the pathogenesis of a wide variety of ischemic heart diseases. Several case reports have shown that CAS due to hypocalcemia can mimic myocardial infarction. However, in all these cases there were coexisting electrolyte abnormalities or other medical conditions that are risk factors for coronary spasm. We describe recurrent acute coronary syndrome in an otherwise healthy young woman without cardiac risk factors caused by coronary spasms, alternatively occurring in all three major coronary arteries. <Learning objective: Isolated hypocalcemia may cause acute coronary artery spasm, leading to recurrent acute coronary syndrome. This unusual cause of recurrent acute coronary syndrome occurred in a young, otherwise healthy female with no risk factors for coronary artery diseases. Medical treatment would resolve the spasm in the large majority of the patients. However, in patients having medically resistant vasospasm, mechanical revascularization may be an option.>.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:26Acute Coronary Syndrome V: Nursing Management
01:27Coronary Artery Disease V: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations