Refractory Coronary Vasospasm Leading to Cardiac Arrest: A Case Report

We present a rare case of refractory coronary vasospasm in a 69-year-old African American male patient, initially misdiagnosed as typical thrombotic acute coronary syndrome (ACS) and treated with placement of a drug-eluting stent. The patient, unfortunately, experienced multiple subsequent readmissions and repeat angiography procedures due to refractory, multivessel vasospasm episodes despite compliance with medical therapy. This ultimately culminated in witnessed ventricular fibrillation arrest, requiring placement of an implantable cardioverter-defibrillator (ICD). This case underscores the diagnostic complexity of vasospastic angina, especially when it mimics obstructive coronary disease and ACS on both clinical presentation and angiography. Long-term management includes appropriate medication titration, patient education on symptom awareness and prompt treatment, and trigger avoidance. Six months post-discharge, the patient reported significant symptomatic improvement, no further hospitalizations, or ICD shocks. This case illustrates the potential severity of multivessel coronary vasospasm and supports a high index of suspicion in cases of unexplained recurrent chest pain, even following successful percutaneous coronary intervention (PCI).