Fifteen coronary angiograms, nine stents, and surgical denervation: unresolved vasospastic angina in a young patient—a case report

TL;DR

A young man with recurring chest pain was mistakenly treated for heart blockages before being diagnosed with a rare condition called vasospastic angina.

Contribution

The case highlights the need for early functional testing to avoid unnecessary procedures in diagnosing vasospastic angina.

Findings

The patient had multiple stents and angiograms but no obstructive disease was found.

Provocative testing confirmed refractory vasospastic angina despite prior treatments.

Autonomic modulation improved symptoms but recurrence suggested ongoing endothelial dysfunction.

Abstract

Vasospastic angina (VSA) can mimic obstructive coronary disease and may lead to overtreatment.

A middle-aged Caucasian man with recurrent chest pain underwent stenting and escalating therapy despite negative angiograms. Subsequent provocative testing confirmed a diagnosis of refractory VSA. Although autonomic modulation improved symptoms, recurrence of symptoms suggested persistent endothelial dysfunction and complex pain mechanisms.

This case underscores the importance of early functional testing to prevent unnecessary interventions and support a tailored, holistic approach to the management of VSA.

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