SHM Converge Scientific Abstract ePoster Gallery-Left Main Coronary Artery Vasospasm: A Misdiagnosed Case of Severe Coronary Artery Disease

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This case report describes a 55-year-old woman with exertional chest pain who was initially thought to have severe left main coronary artery disease. Her evaluation showed inferior T-wave inversions on ECG, normal troponin, normal lipid profile and HbA1c, and a normal echocardiogram with preserved ejection fraction. Nuclear stress testing could not be completed because of a severe reaction to regadenoson.<br /><br />Coronary angiography then showed 70% distal left main coronary artery (LMCA) stenosis, leading to referral for surgery. However, because the patient had no cardiovascular risk factors and the other coronary arteries showed no significant atherosclerosis, clinicians suspected left main coronary artery spasm rather than fixed obstructive disease. A CT coronary angiogram was performed and demonstrated a normal LMCA without stenosis. Repeat catheterization also showed a normal LMCA, confirming coronary artery spasm.<br /><br />The report highlights that coronary artery spasm can closely mimic coronary artery disease on angiography, especially when it involves the left main coronary artery, and may result in unnecessary surgical referral. CT angiography can be useful in distinguishing vasospasm from true stenosis. The authors emphasize maintaining a high index of suspicion for coronary spasm in patients with angina who lack traditional CAD risk factors and have otherwise normal coronary arteries.

Asset Subtitle

Mahmoud Ismayl

Meta Tag

Author List Ahmed Aboeata, Mahmoud Ismayl, Waiel Abusnina

Category Clinical Vignettes

Concept Coronary Vasospasm

Concept Stable Ischemic Heart Disease

Concept Coronary Angiography

Concept Chest Pain

Concept Silent Ischemia

Distinguished Non-Finalist

Presenter Organization Creighton University School of Medicine

Presenting Author Mahmoud Ismayl

Track Adult

Keywords

coronary artery spasm

left main coronary artery

angina

coronary angiography

CT coronary angiogram

vasospasm

chest pain

coronary artery disease

regadenoson reaction

case report

Coronary Vasospasm

Stable Ischemic Heart Disease

Coronary Angiography

Chest Pain

Silent Ischemia