# A case report of a novel approach to the management of refractory coronary vasospasm

## TL;DR

A 46-year-old man with severe coronary vasospasm was successfully treated with corticosteroids and a wearable defibrillator, offering new insights into managing this rare condition.

## Contribution

The paper introduces the use of corticosteroids and wearable defibrillators as novel treatment strategies for refractory coronary vasospasm.

## Key findings

- Corticosteroids may be effective in treating refractory coronary vasospasm linked to presumed inflammation.
- Wearable cardiac defibrillators can both monitor and prevent fatal arrhythmias in high-risk vasospasm patients.
- The patient achieved a good long-term outcome despite high-risk features.

## Abstract

Coronary vasospasm, or vasospastic angina (VSA), is a clinical entity that can uncommonly occur in the setting of non-obstructive coronary disease. Refractory VSA can be associated with significant adverse cardiovascular events, and a paucity of evidence-based guidelines makes this a challenging clinical scenario for clinicians to treat effectively.

A 46-year-old male presenting with a 48 h history of epigastric pain with electrocardiogram changes suggestive of left anterior descending artery stenosis and angiography showing no significant obstructive disease. The patient then developed recurrent early morning chest pain with multi-territory ST elevation despite antispasm therapy with repeat angiography and optical coherence tomography showing no evidence of obstructive disease. The patient was diagnosed with idiopathic refractory coronary vasospasm and ultimately managed with corticosteroids and with a wearable cardiac defibrillator.

The case presented highlights the diagnostics challenges and treatment complexity in managing refractory coronary vasospasm in which our patient experienced a good long-term outcome despite high risk features. Steroids are infrequently used in the management of coronary vasospasm but represent a life-saving treatment option in the setting presumed inflammation. Wearable cardiac defibrillator can be used to both investigate and prevent fatal arrhythmia and should be considered in high-risk coronary vasospasm cohorts.