A Case of Vascular Endothelial Dysfunction Detected Using Reactive Hyperemia-Peripheral Arterial Tonometry Contributed to the Development of Coronary Spastic Angina in a 10-Year-Old Boy

Abstract

The pathophysiology of coronary spastic angina (CSA), which rarely develops in childhood, remains unknown. A 10-year-old boy with a previous history of non-sustained chest pain at rest was admitted to the hospital because of a strong chest pain continuing for 30–40 minutes with a feeling of chest tightness during sleeping. Electrocardiography revealed an ST elevation in a wide range of leads, and myocardial enzyme levels were elevated. Echocardiography revealed no findings to suggest acute myocarditis or structural disease of the coronary artery. We made a diagnosis of CSA and started nitroglycerin therapy, with no pain recurrence. An acetylcholine provocation test induced diffuse spasm in all of the three coronary artery branches and ST elevation in V4–V6. We diagnosed the patient with CSA and started administration of a calcium channel blocker. No CSA recurrence was observed after the treatment. The reactive hyperemia index, which represents vascular endothelial function, was 1.17, as shown by reactive hyperemia-peripheral arterial tonometry. This value was far below the normal value (≥1.67). We suggest that systemic endothelial dysfunction might contribute to the development of CSA in childhood.