PMC3619047_01
(A) ECG in sinus rhythm after defibrillation. ST-segment elevation in the precordial leads, suggestive of transmural anterior ischemia, is present. (B) ECG prior to coronary angiography. The ST-segment has normalized and there is no electrocardiographic sign of ischemia.
amjcaserep-14-76-g001.jpg
PMC3619047_01_amjcaserep-14-76-g001.jpg
f1-amjcaserep-14-76
At arrival in the cathlab, the patient was still sedated and intubated, hemodynamically stable with a blood pressure of 115/73 mm Hg and an ECG with normalization of the ST-T segment (Figure 1B).
(A) Coronary angiography of the right coronary artery (RCA) in left anterior oblique (LAO) 45 . The coronary pressure curve was wedged and a diffuse spasm is present. (B) Coronary angiography of the right coronary artery (RCA) in left anterior oblique (LAO) 45  after nitrates. The spasm has disappeared and the RCA is without significant stenosis. (C) Coronary angiography of the left coronary artery (LCA) in left anterior oblique (LAO) 45 . The RCX and LAD, which was the suspected culprit artery, show no stenosis.
amjcaserep-14-76-g002.jpg
PMC3619047_01_amjcaserep-14-76-g002.jpg
f2-amjcaserep-14-76
A gentle injection of contrast revealed a diffuse spasm of the entire right coronary artery (Figure 2A). After administration of intracoronary nitrates, a gradual normalization of the diameter of the lumen occurred with after one minute an angiographically normal RCA without any stenosis or spasm (Figure 2B). Cannulation of the left coronary artery (LCA) was then performed and contrast injection showed a normal LCA without any lesion or spasm in the left anterior descending artery (LAD), which was the suspected culprit artery (Figure 2C).