Unleashing an Underlying Serious Cardiac Arrhythmia: A Case of Coronary Vasospasm With Atypical Presentation

TL;DR

A 59-year-old patient with syncope and ventricular arrhythmia was found to have coronary vasospasm, diagnosed through multiple tests and treated successfully with calcium channel blockers.

Contribution

This case report presents an atypical clinical presentation of coronary vasospasm and its successful management with calcium channel blockers.

Findings

The patient's syncope and arrhythmia were linked to coronary vasospasm despite normal initial catheterization results.

Calcium channel blocker therapy effectively managed the patient's condition with no further events.

Diagnostic tools like ECG, MRI, and CT angiography were crucial in confirming vasospasm as the cause.

Abstract

This case report highlights the atypical presentation of coronary artery vasospasm in a 59-year-old patient presenting with syncope due to ventricular arrhythmia. Despite initially elevated troponin levels and non-significant lesions observed during left heart catheterization, the patient experienced recurrent chest pain and dizziness, prompting further evaluation. Ultimately, coronary vasospasm was identified as the likely differential diagnosis, supported by various diagnostic modalities including electrocardiogram, Zio patch monitoring, transthoracic echocardiogram, cardiac MRI, and CT angiography. Management involved the initiation of calcium channel blocker therapy, leading to a non-eventful follow-up in the cardiology clinic.

Figures