Unusual Vasospastic Angina: A Documented Asymptomatic Spasm with Normal ECG—A Case Report and a Review of the Literature

We report the case of a 53-years-old patient, known to have coronary artery disease, presenting with typical angina at rest with normal ECG and laboratory findings. His angina is relieved by sublingual nitroglycerin. He had undergone a cardiac catheterisation two weeks prior to his presentation for the same complaints. It showed nonsignificant coronary lesions. Another catheterisation was performed during his current admission. He developed coronary spasm during the procedure, still with no ECG changes. The spasm was reversed by administration of 2 mg of intracoronary isosorbide dinitrate. Variant (Prinzmetal's) angina was diagnosed in the absence of electrical ECG changes during pain episodes.

Exercised-Induced Coronary Spasm in Near Normal Coronary Arteries

In contrast to effort-induced symptoms in obstructive coronary disease, spasm in normal coronary arteries is characterized by angina at rest. We describe a 44-year-old patient with minor coronary plaques and pure exercised-induced coronary spasm. The case questions the differential pathogenic considerations of variant of the variant as opposed to Prinzmetal's variant angina.