The Great Masquerade: Not All Coronary Artery Stenosis Are Created Equal

TL;DR

This case study describes a man with chest pain caused by vasospastic angina, a condition often missed in diagnosis.

Contribution

The paper highlights vasospastic angina as an underdiagnosed cause of chest pain and outlines its diagnosis and treatment.

Findings

Intracoronary nitroglycerin resolved pseudostenosis in the left main artery, confirming vasospasm.

Vasospastic angina was diagnosed and treated with lifestyle changes and medical therapy.

The case emphasizes the importance of considering VA in patients with atypical coronary artery stenosis.

Abstract

We present the case of a 60-year-old male, with active smoking and cocaine use disorder, who reported progressive chest pain. Various anatomical and functional cardiac imaging, performed to further evaluate chest pain etiology, revealed changing severity and distribution of left main artery (LMA) stenosis, raising suspicion for vasospasm. Intracoronary nitroglycerin relieved the vasospasm, with resolution of the LMA pseudostenosis. A diagnosis of vasospastic angina (VA) led to starting appropriate medical therapy with lifestyle modification counselling. This case highlights VA, a frequently underdiagnosed etiology of angina pectoris. We discuss when to suspect VA, its appropriate work-up, and management.

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