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Case Report: Delayed diagnosis: a case of left main coronary artery spasm

Yaxin Zhi1, Wei Sun1, Ziqiao Zhang1

  • 1Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.

Frontiers in Cardiovascular Medicine
|March 3, 2025
PubMed

Insights

Left main coronary artery (LMCA) spasm, a rare but fatal condition, can mimic stenosis. This case highlights the importance of considering LMCA spasm to avoid misdiagnosis and ensure proper treatment.

Area of Science:

  • Cardiology
  • Vascular Medicine

Background:

  • Left main coronary artery (LMCA) spasm is a rare but life-threatening condition.
  • Recurrent chest pain can be a symptom of LMCA lesions.

Observation:

  • A patient initially diagnosed with severe LMCA stenosis underwent coronary artery bypass grafting (CABG).
  • Nine years post-CABG, the patient presented with similar symptoms, but repeat coronary angiography (CAG) revealed no significant LMCA stenosis.

Findings:

  • The recurrent symptoms and absence of stenosis on repeat CAG led to a diagnosis of LMCA spasm.
  • This underscores the potential for LMCA spasm to be misdiagnosed as fixed stenosis.

Implications:

  • Interventional cardiologists must consider LMCA spasm in the differential diagnosis of LMCA lesions.
  • Thorough clinical judgment and pretreatment are crucial to prevent misdiagnosis and ensure appropriate management of LMCA conditions.

Keywords:
anginacoronary angiography (CAG)coronary artery bypass grafting (CABG)coronary artery spasm (CAS)left main coronary artery (LMCA) spasm

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