The Great Masquerade: Not All Coronary Artery Stenosis Are Created Equal

Authors

Prasanti A Kotta
Ajit K Koduri
Jeffrey Berman
Veronica V Rosen
Waleed T Kayani

Publication Date

1-1-2024

Journal

Methodist DeBakey Cardiovascular J

DOI

10.14797/mdcvj.1365

PMID

38799179

PMCID

CID: PMC11122690

PubMedCentral® Posted Date

5-20-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Male, Middle Aged, Coronary Stenosis, Coronary Vasospasm, Nitroglycerin, Coronary Angiography, Treatment Outcome, Vasodilator Agents, Predictive Value of Tests, Cocaine-Related Disorders, Severity of Illness Index, Angina Pectoris, Diagnosis, Differential, Smoking, vasospastic angina, intravascular ultrasound, intracoronary NTG, myocardial bridging

Abstract

We present the case of a 60-year-old male, with active smoking and cocaine use disorder, who reported progressive chest pain. Various anatomical and functional cardiac imaging, performed to further evaluate chest pain etiology, revealed changing severity and distribution of left main artery (LMA) stenosis, raising suspicion for vasospasm. Intracoronary nitroglycerin relieved the vasospasm, with resolution of the LMA pseudostenosis. A diagnosis of vasospastic angina (VA) led to starting appropriate medical therapy with lifestyle modification counselling. This case highlights VA, a frequently underdiagnosed etiology of angina pectoris. We discuss when to suspect VA, its appropriate work-up, and management.