Coronary Vasospasm Presenting as ST-Elevation Myocardial Infarction

Vasospastic angina (VSA), also known as Prinzmetal angina, is caused by reversible diffuse or focal vasoconstriction of coronary arteries. It is the most common diagnosis among patients presenting with signs of ischemia but no obstructive coronary artery disease. Patients with VSA can present with typical acute coronary syndrome (ACS) symptoms of chest pain or pressure, dyspnea, diaphoresis, fatigue, and syncope. VSA is a challenging diagnosis for physicians due to its nearly identical clinical presentation to active acute coronary syndrome patients. This report describes a similar diagnosis dilemma when a 69-year-old female presented with ST-elevation myocardial infarction (STEMI), who was eventually diagnosed with and treated for vasospastic angina.