# A Case of Refractory Variant Angina

## TL;DR

This paper presents a case of a woman with severe variant angina that was not diagnosed using a standard spasm provocation test, highlighting the test's limitations.

## Contribution

The paper highlights the limitations of pharmacologic spasm provocation testing in diagnosing refractory variant angina.

## Key findings

- A 61-year-old woman had refractory variant angina despite a negative spasm provocation test.
- She experienced recurrent acute coronary syndrome due to undiagnosed coronary vasospasm.
- Physicians should be cautious about relying solely on spasm provocation tests for diagnosis.

## Abstract

Coronary vasospasm is defined as the abnormal contraction of an epicardial coronary artery. Variant angina is a severe form of coronary vasospasm, reflecting transmural ischemia with ST-T elevation on an electrocardiogram. A pharmacologic spasm provocation test during coronary angiography is the gold standard evaluation for patients who have not been diagnosed with coronary vasospasm by a non-invasive test. The sensitivity and specificity of pharmacologic spasm provocation testing have been reported to be very high in patients with variant angina. Here, we report the case of a 61-year-old woman who had refractory variant angina. Although a pharmacologic spasm provocation test did not lead to a definitive diagnosis, she had recurrent acute coronary syndrome due to coronary vasospasm. Physicians should be aware of the limitations of the spasm provocation test, even in patients with refractory variant angina.