case_images: PMC10768985_01
case_images: (A) A 12-lead electrocardiogram showing no abnormal findings. (B) Computed tomography coronary angiogram of the left anterior descending coronary artery, revealing moderate organic stenosis in the proximal part. (C) Computed tomography coronary angiogram of the right coronary artery, indicating the absence of organic stenosis.
case_images: ytad638f1.jpg
case_images: PMC10768985_01_ytad638f1.jpg
case_images: ytad638-F1
case_images: Both the electrocardiogram (Figure 1A) and transthoracic echocardiogram showed no abnormal findings. A computed tomography coronary angiogram revealed a moderate stenosis at the proximal site of the left anterior descending coronary artery and diagonal coronary artery (Figure 1B) with no stenosis in the right coronary artery (Figure 1C).
case_images: (A) Baseline invasive coronary angiogram, illustrating a spastic left coronary with organic stenosis at the proximal part of the left anterior descending coronary artery and diagonal branch. (B) Invasive angiogram after a hand grip test, showing an increased severity of stenosis in the proximal part of the left anterior descending coronary artery and diagonal branch. The flow distal to the diagonal branch is delayed. (C) Invasive angiogram after the administration of nitrate, indicating a dilated coronary artery. There is a residual organic stenosis in the proximal part of left anterior descending coronary artery and diagonal branch. (D) A 12-lead electrocardiogram taken at the end of the hand grip test, revealing elevated ST segments in leads II, III, and aVF.
case_images: ytad638f2.jpg
case_images: PMC10768985_01_ytad638f2.jpg
case_images: ytad638-F2
case_images: The baseline coronary angiogram revealed a relatively spastic coronary artery, which describes the condition of coronary artery with relatively even and diffuse reductions in vessel diameter along the coronary artery in angiography (Figure 2A). At the end of the 5 min hand grip test, an increase in heart rate and blood pressure was observed, and the patient reported chest pain accompanied by prominent ST elevation in leads II, III, and aVF (Figure 2D). Angiogram revealed spasm at the site of the organic stenosis with delayed flow in his diagonal coronary artery (Figure 2B). Following nitrate administration, the left coronary artery angiogram showed residual organic stenosis in the proximal part of the left anterior descending coronary artery and the diagonal branch (Figure 2C).