Campfire Smoke as a Plausible Trigger for Vasospastic Angina: Insights From a Case Report

BACKGROUND Vasospastic angina (Prinzmetal angina) has been linked to many risk factors, including tobacco smoking. Although numerous studies have reported associations between air pollutants and cardiovascular outcomes, the relationship with vasospastic angina remains poorly documented. We report the case of a 45-year-old man with normal coronary arteries who developed episodes of chest pain due to vasospastic angina following inhalation of campfire smoke. CASE REPORT A 45-year-old man with a history of eczema, dyslipidemia, Gramineae allergy, and past tobacco use participated in a 3-day camping trip during which he was regularly exposed to campfire smoke. Two days later, and with an otherwise negative environmental history, he began experiencing episodes of chest pain at rest. Exercise-stress electrocardiography was clinically negative. Coronography showed no significant stenosis. Cardiac magnetic resonance imaging (MRI) showed no myocardial fibrosis. Positron emission tomography (PET) showed no myocardial ischemia or necrotic sequelae. The diagnosis of vasospastic angina was eventually confirmed by an acetylcholine provocation test. While exposure to campfire smoke may have acted as a trigger, other contributing factors, including prior tobacco use, allergy history, and potential genetic susceptibility, could also have contributed to the development of vasospastic angina in this patient. CONCLUSIONS This case report suggests that air pollution exposure, such as campfire smoke, can act as a trigger for vasospastic angina and highlights the need for further studies to assess this relationship. From a public health perspective, identifying and avoiding potential triggers remains an important measure that can complement existing preventive strategies for cardiovascular diseases.