Coronary artery spasm: mimicry, misdiagnosis and misfortune

A 51-year-old man with a history of ischaemic heart disease (IHD), previous percutaneous coronary intervention (PCI) and rheumatoid disease, presented with chest pain and inferoposterior ST segment elevation in August 2013. He had continued to smoke after his diagnosis of IHD and PCI. In 2006, he presented with an acute coronary syndrome (ACS) and had a significant left anterior descending artery (LAD) stenosis, which was treated with one stent (figure 1A, B). He presented again in 2007 with in-stent restenosis, and a second stent was implanted (figure 1C, D). In April 2013, he had an emergency presentation with stent thrombosis and a third stent was implanted in the LAD (figure 1E, F). Figure 1 Coronary angiogram showing …