Dynamic Visualization of Vasospastic Angina

A 57-year-old Japanese male with past medical history of coronary artery disease, coronary artery bypass graft, percutaneous coronary intervention with known in-stent-restenosis, diabetes mellitus, and tobacco abuse presented to the emergency department with left sided chest pressure that woke him from sleep. The pressure was constant, non-radiating, and associated with shortness of breath. EKG displayed ST segment elevation in the inferior and anterior leads (Figure, A). Coronary angiography revealed patent grafts and severe spasm involving the proximal and middle segments of the right coronary artery (B).