Vasospastic myocardial infarction: An even rarer occurrence of a rare entity.

Vasospastic angina (VSA) is an important functional cardiac disorder that leads to transient myocardial ischemia and is caused by sudden, intense and reversible coronary artery spasm resulting in subtotal or total occlusion.[1,2] VSA is associated with cardiac conditions such as stable or unstable angina, acute coronary syndromes and lethal arrhythmias. The patients usually present with chest pain, which might or might not be accompanied with ischemic ECG changes.[1,3] Vasospasm is predominantly caused by hyper-reactive vascular smooth muscle cells and probably endothelial dysfunction.[4] It is also reported that prolonged VSA may cause acute myocardial infarction.[2] The prevalence of VSA is known to be as low as 1% to 1.5% of angina admissions.[2] Although the widespread use of calcium channel blockers (CCB) in patients with coronary artery disease (CAD) prevents the occurrence of VSA attacks in susceptible population, 10% to 20% of VSA patients are either resistant or cannot use CCBs due to side effects.[2] Here we report a patient who suffered acute myocardial infarction (AMI) due to documented VSA with no critical coronary lesions.