Severe Coronary Vasospasm and the Role of Nontraditional Risk Factors
Abstract
Background: Coronary artery vasospasm is an under-recognized cause of myocardial ischemia that mimics acute coronary syndromes and poses a diagnostic challenge in patients with complex comorbidities.
Case summary: A 71-year-old woman with IgG multiple myeloma on chemotherapy with a history of hypertension and chronic atopy with late-onset asthma, developed a presyncopal episode during a routine oncology visit. She was hypotensive with transient complete heart block and ventricular tachycardia. Electrocardiogram showed inferior ST-segment elevations and elevated cardiac biomarkers. Coronary angiography revealed severe right coronary artery spasm that resolved with nitroglycerin. Cardiac magnetic resonance imaging showed myocardial edema without late gadolinium enhancement. Her unique atopic history and recent steroid use were identified as contributing factors. She was discharged on amlodipine and nitroglycerin.
Discussion: This case highlights the role of nontraditional risk factors, particularly atopy and steroid use, in promoting coronary vasospasms.
Take-home message: Early recognition of coronary vasospasms is essential to prevent complications.
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials
- Tocilizumab in patients with severe COVID-19: a retrospective cohort study
- A new aging measure captures morbidity and mortality risk across diverse subpopulations from NHANES IV: A cohort study
- Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study
- Are noise and air pollution related to the incidence of dementia? A cohort study in London, England
- Long COVID symptoms and duration in SARS-CoV-2 positive children — a nationwide cohort study
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.