Vasospastic Angina Confirmed by Nitrate Challenge: A Case Report

A 61-year-old male smoker with hypertension presented with exertional chest pain and minor troponin elevation. ECG showed apico-lateral T wave inversions. A positive stress test led to coronary angiography, which revealed a subocclusion of the right coronary artery. After intracoronary nitrate injection, the lesion resolved completely, confirming coronary artery spasm. Vasospastic angina remains an underdiagnosed cause of chest pain and can mimic fixed coronary lesions, potentially leading to unnecessary interventions. Smoking is a key risk factor, and nitrate responsiveness is critical for diagnosis. This case highlights the importance of recognizing functional coronary obstruction and the role of nitrates in avoiding misdiagnosis.