Abstract
The patient was 13 years old boy. He woke up early in the morning at 5 o’clock because of chest oppression on September 10, 2011. He had sometimes chest oppression on dynamic exercise since 11 years old. His cardiac echocardiogram showed decreased percent fractional shortening at the near clinic. Long-acting calcium channel antagonist was administered in the morning once a day. Two weeks later, his percent fractional shortening on echocardiogram dramatically improved and also his chest discomfort on both rest and effort decreased about a half level. However he had residual chest oppression on exercise. Cardiac catheterization was performed under no medication at least 48 hours. Coronary angiogram showed no fixed stenosis. Intracoronary administration of acetylcholine caused diffuse narrowing on the right coronary and the left anterior descending artery accompanied by significant ECG changes and his chest pain. Intracoronary administration of ergonovine did not cause spasm or no chest pain/ECG changes. Adding intracoronary administration of acetylcholine after ergonovine injection caused severe spasm on the left anterior descending artery and the left circumflex artery (so called as withered branch), accompanied by severe chest pain/cold sweating and significant ECG changes. He was diagnosed as multiple coronary spastic angina.
