Myocardial ischemia with normal coronary vessels. Indication of a vasospastic etiology

In a 43-year-old woman with ECG changes of an acute anterior and posterior wall infarct, associated symptoms and biochemical findings, coronary angiography demonstrated normal coronary arteries and a normal variant in the course of the left coronary artery. Vasospasms in another vascular bed (migraine) and highly positive 201-Thallium scintigraphy during acral cold provocation speak for coronary spasm as cause of the myocardial ischaemia in this patient.