Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2020; 8(16): 3601-3607
Published online Aug 26, 2020. doi: 10.12998/wjcc.v8.i16.3601
Spontaneous multivessel coronary artery spasm diagnosed with intravascular ultrasound imaging: A case report
Hao-Yu Wu, Yi-Wei Cao, Feng-Jun Chang, Lei Liang
Hao-Yu Wu, Yi-Wei Cao, Feng-Jun Chang, Lei Liang, Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
Author contributions: Wu HY, Cao YW, and Liang L drafted the manuscript; Wu HY, Cao YW, Chang FJ and Liang L participated in the treatment of this patient; Wu HY and Liang L supervised the treatment and revised the manuscript; all authors approved the final version of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lei Liang, MD, PhD, Professor, Doctor, Teacher, Department of Cardiology, Shaanxi Provincial People's Hospital, No. 256 West Youyi Road, Xi'an 710068, Shaanxi Province, China. wxs5132006@126.com
Received: March 3, 2020
Peer-review started: March 3, 2020
First decision: April 24, 2020
Revised: May 27, 2020
Accepted: July 16, 2020
Article in press: July 16, 2020
Published online: August 26, 2020
Abstract
BACKGROUND

Coronary artery spasm is a major cause of myocardial ischemia. Although coronary artery spasm has been known for a long time, its mechanism has not yet been identified. Many clinicians, especially young clinicians pay less attention to coronary artery spasm, which may lead to some patients not being appropriately diagnosed and treated in time. We report a patient with spontaneous multivessel coronary artery spasm for more than 30 years diagnosed with intravascular ultrasound (IVUS) imaging.

CASE SUMMARY

A 66-year-old Chinese male patient had chest squeezing at rest for more than 30 years. He had a history of cigarette smoking for more than 40 years and hypertension for 10 years. Before presenting at our institution, the patient had undergone coronary angiography 4 times and percutaneous transluminal coronary angioplasty procedures twice at other hospitals without a diagnosis of coronary artery spasm. However, his chest symptoms worsened. Spontaneous multivessel coronary artery spasm occurred during IVUS without provocation testing, and the IVUS image was recorded. Thus, the diagnosis of multifocal spontaneous coronary artery spasm was confirmed. The patient was placed on oral diltiazem, isosorbide mononitrate, and nicorandil to suppress coronary artery spasms. All medications were given at the maximum dosages tolerated by the patient. He was discharged after 5 d without complications. During the six-month follow-up period, the patient was symptom-free.

CONCLUSION

Coronary artery spasm is still prevalent in Eastern countries. It is essential for clinicians to be aware of coronary artery spasm, which may be hard to detect and can be lethal, in order to diagnose and treat patients appropriately.

Keywords: Coronary artery spasm, Multivessel coronary, Spontaneous, Intravascular ultrasound, Case report

Core tip: Coronary artery spasm is an important cause of myocardial ischemia. Although coronary artery spasm has been known for a long time, its mechanisms have not yet been identified. Coronary artery spasm is prevalent in Asian countries, but many clinicians, especially young clinicians, pay less attention to coronary artery spasm, which may result in misdiagnosis and mistreatment. It is essential for clinicians to be aware of coronary artery spasm, which may be hard to detect but can be lethal, in order to diagnose and treat patients appropriately.