Acute coronary syndrome as the first symptom of vasospastic angina – case report of a 38-year-old man with myocardial infarction with non-obstructive coronary artery disease

Abstract

A 38-year-old obese man with hypertension and a twenty-year history of nicotinism was admitted for a suspected ST-segment elevation myocardial infarction (STEMI). Coronary angiography did not reveal significant coronary artery stenosis, which, together with symptoms of acute coronary syndrome and increased troponin I levels, led to the diagnosis of myocardial infarction with non-obstructive coronary artery disease (MINOCA) and implied a differential diagnosis. Given the clinical picture, a provocative test with acetylcholine was performed, which indicated the vasoconstrictive origin of MINOCA. In order to reduce the likelihood of another episode, pharmacotherapy was changed and lifestyle changes were recommended.

Keywords

• stemi
• coronary artery spasm
• acetylcholine
• minoca
• provocation test
• vsa
• vasospastic angina