# Case Report: Left main coronary artery spasm in monozygotic twins patients with vasospastic angina

## TL;DR

Identical twins developed coronary artery spasm without traditional risk factors, suggesting a genetic cause.

## Contribution

Provides clinical evidence for genetic predisposition to coronary artery spasm in monozygotic twins.

## Key findings

- Identical twins with no cardiovascular risk factors developed coronary artery spasm.
- Coronary angiograms showed spontaneous spasm in multiple arteries in both twins.
- The case highlights the need for familial screening in vasospastic angina.

## Abstract

Coronary artery spasm (CAS), a known cause of myocardial ischemia that can present as variant angina, is primarily triggered by intraoperative catheter manipulation. Evidence for a genetic predisposition to coronary artery spasm is scarce. This report describes a case involving identical twins with no conventional cardiovascular risk factors who successively developed CAS. Their coronary angiograms showed spontaneous spasm in left main coronary artery, left circumflex branch artery and left anterior descending artery. This case provides clinical evidence for a genetic predisposition to CAS, highlighting the critical need for familial screening—particularly the proactive screening of the other twin when one monozygotic twin is diagnosed with vasospastic angina.