Severe Coronary Vasospasm and the Role of Nontraditional Risk Factors

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.