# Uncovering a hidden danger: a case report of diffuse coronary spasm concealing spontaneous coronary artery dissection

## TL;DR

A young woman with chest pain was found to have a rare heart condition hidden by a spasm, diagnosed using advanced imaging techniques.

## Contribution

This case highlights the importance of using advanced imaging to diagnose rare heart conditions that may be masked by spasm.

## Key findings

- A young woman with no risk factors presented with acute chest pain and a subcritical stenosis on angiography.
- Optical coherence tomography and intravascular ultrasound revealed extensive spontaneous coronary artery dissection.
- Conservative treatment and follow-up with cardiac CT angiography confirmed no disease progression.

## Abstract

Over recent years, spontaneous coronary artery dissection (SCAD) has emerged as a no longer rare cause of acute coronary syndrome (ACS). On the other hand, coronary artery spasm (CAS) is the main cause of ischemic heart disease with non-obstructive coronary lesions. Clinical manifestations of both vary from stable angina to ACS or, rarely, sudden cardiac death. These entities may be underdiagnosed on a coronary angiography.

We report the case of a young woman presenting with acute chest pain and no coronary risk factors. Angiography revealed a focal subcritical stenosis of the right coronary artery. Coronary wiring resulted in diffuse and critical spasm. However, optical coherence tomography (OCT) and intravascular ultrasound (IVUS) showed extensive SCAD. She was therefore treated conservatively. On the fourth day, cardiac computed tomography angiography (CCTA) excluded disease progression, and then she was discharged on medical therapy.

Combined IVI plays a vital role in providing accurate and detailed visualization of the coronary anatomy and thus allowing for more precise diagnosis, risk stratification, and treatment planning. CCTA can be considered a valuable tool in the noninvasive follow-up of SCAD.