STEMI secondary to coronary spasm in a young healthy man

Vasospastic angina is a clinical and physio-pathological entity, which has been documented for many years. Patients with evidence of myocardial infarction with non-obstructive coronary arteries (MINOCA) and ischemia with non-obstructive coronary arteries (INOCA), a condition associated with adverse cardiovascular outcomes, are becoming increasingly recognized. Underlying mechanisms of MINOCA, such as coronary microvascular spasm, represent a diagnostic and therapeutic challenge to clinicians.We reported a 24-year-old healthy man presented with typical chest pain started at midnight. His first electrocardiogram (ECG) revealed significant ST elevation in inferior leads with elevated cardiac troponin I. The patient transferred to catheterization laboratory for primary percutaneous coronary intervention (PCI), but despite our anticipation emergent coronary angiography (CAG) demonstrated normal coronary. The most probable reason to explain this kind of situation is coronary vasospasm. After 2 days with no symptoms the patient experienced an atypical chest pain radiate to right trapezius muscle and worsened with inspiration. Therefore his physician started high dose NSAIDs with impression to pericarditis then his complain resolved.This case presentation provides an example demonstrating that coronary vasospasm can lead to myocardial infarction with non-obstructive coronary arteries (MINOCA) and should be considered for healthy patients with normal coronary arteries.

Keywords:

STEMI , coronary vasospasm , pericarditis