A 38-year-old man had transient left posterior hemiblock and ST-segment elevation in leads II, III, and aVF during chest pain. Following sublingual administration of nitroglycerin, the chest pain subsided and the right axis deviation and ST elevation returned to normal. Coronary arteriogram revealed no significant occlusion of major coronary arteries, but collaterals were seen extending from the posterior descending artery up through the interventricular septum. This suggested that the septal branch of the left anterior descending artery had severe stenosis. This report is of a case of variant angina, documents right axis deviation as a feature of coronary spasm, and supports the concept of ischemic left posterior hemiblock.
