Coronary Artery Vasospasm Presenting as Non-ST Segment Elevation Myocardial Infarction in a Nigerian Female: A Case Report

Coronary artery spasm (CAV) is characterized by transient vasoconstriction of normal or diseased epicardial coronary arteries, with a resultant reduction in myocardial perfusion, ischemia, infarction, or sudden cardiac death. Although the precise pathophysiologic mechanism of CAV remains unclear, vascular smooth cell contraction constitutes a core underlying feature. A 46-year-old Nigerian woman with pre-existing hypertension was admitted following an episode of chest pain; subsequent elevation of cardiac biomarkers and electrocardiogram showing T-wave inversions in the anterolateral and inferior leads led to the diagnosis of non-ST-elevation myocardial infarction (NSTEMI). Coronary angiography was performed as part of an early invasive strategy. CAV was diagnosed by coronary angiography, which demonstrated diffuse constriction of the left anterior descending artery (LAD) in its mid and distal segments. Selective contrast injection into the left coronary system reproduced her typical chest pain symptom accompanied by transient ST-segment elevation in lead V1, which resolved spontaneously. This case underscores that CAV is a pan-ethnic phenomenon that must be considered in the differential diagnosis of acute coronary syndrome across diverse patient populations. Provocative testing during angiography remains the diagnostic cornerstone. Management hinges on long-acting nitrates and calcium channel blockers for prevention, while avoiding non-selective beta-blockers. Prompt diagnosis and management, contingent upon clinical suspicion, are vital to preventing lethal complications. This report highlights the importance of recognizing CAV beyond its classic demographic associations to ensure equitable and effective care.