Abstract
A 61-year-old Japanese man during posted overseas in Southeast Asia complained chest oppression with cold sweating for >30 minutes during the disaster of great flood in Thailand because of hard work, mental stress, and short sleep time (2–3 hours). He admitted to the cardiology clinic urgently. He was diagnosed as acute coronary syndrome without elevation of cardiac enzyme or abnormal findings on ECG. Emergency coronary angiography was performed but no flow limiting vessel was found. Percutaneous coronary intervention (PCI) was performed on moderate stenotic lesion (50%) at diagonal branch. Dual anti-platelet agents, strong statin, and β-blocker was administered after the PCI procedures. He had complained chest discomfort at early morning for a few minutes one or two times per month since one year ago. When he came back to Japan, he admitted to our hospital for the evaluation of second opinion. From the detailed anamnesis and other examinations (cardiac scintigrams and echo-cardiograms), we judged that his chest oppression attack might be due to coronary artery spasm because of hard work and mental stress. We recommend the administration of calcium channel blocker instead of β-blocker and quit the β-blocker intake. We should transmit the importance of coronary artery spasm for the cardiologists in not only Europe and USA but also Southeast Asia.
