Coronary Vasospasm Presenting in a Catastrophic Way

Coronary artery vasospasm is an under-recognized yet fatal condition that can manifest as sudden cardiac arrest. A 51-year-old man presented with out-of-hospital cardiac arrest due to ventricular fibrillation during exercise. Coronary angiogram showed severe disease at ostial left main coronary artery and left anterior descending artery (LAD), that was not present anymore on repeated angiography and intravascular ultrasound assessment. Cardiac magnetic resonance demonstrated evidence of prior myocardial infarction in the LAD territory. Acetylcholine challenge test was performed that induced severe left main coronary artery and LAD spasm. Coronary artery vasospasm has contributed to a significant proportion of patients presenting with coronary artery disease. Establishing the correct diagnosis is detrimental to future management of patients. This case highlighted a multimodality approach in the diagnosis of coronary vasospasm.