Abstract
Background: Coronary spastic angina, a syndrome caused by coronary spasms, is extremely rare in children. We encountered two teenagers where coronary spastic angina had been diagnosed based on coronary angiography and an intracoronary injection of acetylcholine. Case 1: An 11-year-old boy who had no medical history related to coronary artery disease, such as Kawasaki disease, was admitted to our hospital complaining of nausea, dyspnea, and precordialgia in the early morning. On admission, the patient's troponin T test was positive and the results of electrocardiography were normal. Eight hours later, ST elevations was seen in leads V2 and V3. Coronary angiography revealed no stenosis; however, the left anterior descending artery showed diffuse stenosis after injection of acetylcholine (50 µg) into the left coronary artery. Case 2: A 14-year-old girl was admitted for dyspnea and chest pain in the early morning. On admission, the troponin T test was positive, but the results of electrocardiography and echocardiography were normal. She experienced severe chest pain with ST elevations in leads II, III, aVF, and V3-6 after hospitalization. Coronary angiography revealed no stenosis, but there was diffuse stenosis in the left anterior descending artery and the circumflex branch after injection of acetylcholine (50 µg). Conclusions: When pediatric patients complain of chest pain and coronary angiography shows no stenosis, the addition of a coronary spasm provocation test is highly recommended. Faster diagnoses can contribute to better outcomes for pediatric coronary spastic angina patients.
