Acute Myocardial Ischemia Secondary to Coronary Vasospasm From Long-Term High-Dose Caffeine Consumption

Chest pain is a prevalent emergency department (ED) complaint, with approximately 20 million annual visits in North America and Europe. Acute ST-elevation myocardial infarction (STEMI) is a critical diagnosis among these complaints, but numerous STEMI mimics, such as variant (Prinzmetal) angina, complicate diagnosis and resource allocation. Variant angina, a reversible coronary vasospasm, is a rare diagnosis often labeled as nonobstructive coronary artery disease. The prevalence of coronary vasospasm is low, making it challenging to quantify. Various mechanisms, including arterial wall dysfunction and vasoactive substances, are hypothesized to precipitate vasospastic events. This case details a confirmed instance of variant angina in a 30-year-old, physically fit male firefighter who consumed approximately 900 mg of caffeine daily. Unlike previously documented cases of cardiac vasospasm following a single massive overdose, this report highlights the association between chronic high caffeine consumption and confirmed vasospasm for the first time.