Global coronary arteries spasm in a young patient
A 42-year-old smoker man without history of cardiac problem and no other cardiac risk factors presented with one episode syncope and was referred to our cardiology clinic for work-up. His syncope was sudden, with no triggered factor, tongue biting, abnormal movement, lower limb weakness and blurred vision and chest pain. He had negative T inversion in anterior leads, therefore we admitted him in our ward.\nOn admission, heart rate was 56 beats/min, blood pressure was 110/70 mmHg, and he was breathing at a rate of 12 per minute, with oxygen saturations around 95% on room air. Cardiovascular examination was normal. There was not orthostatic change. Blood chemistry was normal including cholesterol levels. Asymptomatic episodes of ST-segment elevation were revealed in the 24-hour Holter monitoring and we decided to perform coronary angiography. Echocardiogram was normal. His coronary angiogram showed diffuse significant narrowing of proximal left anterior descending artery (LAD), 90% osteal stenosis of large obtuse marginal (OM), 90% diffuse narrowing of proximal right coronary artery (RCA) ( and ).\nWe decided to perform multivessel percutaneous coronary intervention (PCI) for him, but after intra-coronary injection of nitrate, amazingly his angiogram became completely normal ( and ). There was no organic coronary stenosis. Patient symptoms were completely resolved and he discharged on diltiazem and nitroglycerine, one month later he presented with sudden cardiac death.