A 48-year-old woman comes to the emergency room with chest pain. She describes the pain as a squeezing sensation in her chest with radiation to the left shoulder. The episode began about 15 minutes ago when she was sitting reading a book. She has had this pain before, typically in the evenings, though prior episodes usually resolved after a couple of minutes. Her pulse is 112/min, blood pressure is 121/87 mm Hg, and respiratory rate is 21/min. An ECG shows ST-segment elevations in the inferior leads. The patient is given nitroglycerin, which improves her symptoms. Percutaneous coronary angiography is performed, and no obstructive lesions are observed. Which of the following is most likely to be involved in the pathogenesis of this patient's chest pain?

Question

A 48-year-old woman comes to the emergency room with chest pain. She describes the pain as a squeezing sensation in her chest with radiation to the left shoulder. The episode began about 15 minutes ago when she was sitting reading a book. She has had this pain before, typically in the evenings, though prior episodes usually resolved after a couple of minutes. Her pulse is 112/min, blood pressure is 121/87 mm Hg, and respiratory rate is 21/min. An ECG shows ST-segment elevations in the inferior leads. The patient is given nitroglycerin, which improves her symptoms.  Percutaneous coronary angiography is performed, and no obstructive lesions are observed.  Which of the following is most likely to be involved in the pathogenesis of this patient's chest pain?

Quizplus · Accepted Answer

Eductional Objective: Vasospastic angina involves hyperreactivity of coronary artery smooth muscle.  Patients are usually young (age <50) and without significant risk factors for coronary artery disease; they experience recurrent episodes of chest discomfort that typically occur during rest or sleep and resolve within 15 minutes.

A 48-Year-Old Woman Comes to the Emergency Room with Chest