Spastic coronary artery. Correlation of the myocardium at risk in the functional and anatomic study with myocardial perfusion scintigraphy and coronary angiography

Abstract A 52-year-old patient, with symptoms of angina in the last month, was referred to undergo a SPECT myocardial perfusion. At an early stage of the exercise test, he showed electrical changes suggestive of inferior ischemia and the scintigraphy images showed intense and extensive inferolateral hypoperfusion during the stress, with complete reversibility at rest. Coronary angiography showed a right coronary artery without obstructive lesions. An endothelial dysfunction test with acetylcholine provoked diffuse spasm of the artery, which retrograded completely with intravenous nitroglycerin. An acute coronary syndrome may have causes other than obstructive lesions in epicardial arteries that induce myocardium at risk. The ischemic tissue can be identified by imaging techniques which guides the invasive studies to recognize dysfunctional coronary arteries.