# ST-Elevation Myocardial Infarction Due to Coronary Vasospasm Associated with Eosinophilic Granulomatosis with Polyangiitis: A Case Report

## TL;DR

A rare case of heart attack caused by coronary vasospasm linked to a rare autoimmune disease is described, highlighting unusual treatment approaches.

## Contribution

This paper presents a unique clinical case linking STEMI with coronary vasospasm and EGPA, emphasizing diagnostic and therapeutic challenges.

## Key findings

- A 54-year-old man with EGPA presented with STEMI due to coronary vasospasm.
- Intra-coronary nitroglycerin and calcium channel blockers resolved the vasospastic lesion.
- The case underscores the importance of considering EGPA in patients with unexplained STEMI.

## Abstract

ST-elevation myocardial infarction (STEMI) can be caused by underlying coronary artery vasospasm (CAV) with or without associated atherosclerotic disease. Coronary artery vasospasm is a rare but potentially devastating manifestation of eosinophilic granulomatosis with polyangiitis (EGPA).

We describe a 54-year-old male with a known history of EGPA and coronary artery disease presenting to the emergency department with chest pain and an inferior STEMI on electrocardiogram. He was ultimately taken for coronary angiography and found to have a discrete vasospastic lesion in the right coronary artery that was treated with intra-coronary nitroglycerin and calcium channel blockers. He was continued on immunosuppressant agents (prednisone and mepolizumab) for management of EGPA and followed up with outpatient cardiology and rheumatology for vasospastic angina.

This case highlights a rare cause of STEMI, discusses the nuances in treatment of STEMI due to CAV, and provides background on pathophysiology and treatment of EGPA.