A case report of a multivessel coronary vasospasm that responded to IV diazepam.

RATIONALE

Coronary artery vasospasm (CAVS) is a significant cause of acute chest syndrome, often mimicking coronary artery disease on angiography, which may lead to unnecessary interventions like percutaneous coronary intervention or coronary artery bypass grafting. This case report aims to highlight the potential therapeutic role of intravenous (IV) diazepam in managing multivessel CAVS unresponsive to standard vasodilators, emphasizing the influence of psychological stress in such cases.

PATIENT CONCERNS

A 32-year-old male, a heavy smoker with a history of anxiety disorder and no familial coronary artery disease history, presented with angina.

DIAGNOSES

Initial evaluations, including electrocardiogram, echocardiogram, and laboratory tests, were normal, but an exercise stress electrocardiogram was positive. Coronary angiography revealed severe lesions in the proximal left anterior descending and right coronary artery diagnosing multivessel CAVS.

INTERVENTIONS

The patient was unresponsive to intracoronary nitroglycerin and verapamil. During a panic attack in the procedure, 5 mg IV diazepam was administered.

OUTCOMES

Treatment lead to symptom resolution and normal coronary arteries on repeat angiography, without plaques or stenosis.

LESSONS

This case demonstrates multivessel CAVS refractory to standard vasodilators but responsive to IV diazepam, as evidenced by angiographic resolution. The temporal association with a panic attack suggests a link to psychological stress, aligning with literature on stress-related cardiovascular events. Limitations include the single-case design, lack of provocation testing, and inability to definitively establish causality between anxiety and vasospasm, necessitating larger studies to confirm IV diazepam's efficacy. Multivessel CAVS may respond to IV diazepam when standard treatments fail, particularly in cases associated with psychological stress. This case underscores the need for further research to validate the therapeutic potential of IV benzodiazepines in managing CAVS and to explore the interplay between psychological stress and cardiovascular events.