Coronary artery spasm occurring late after vein graft surgery.

A patient with classic effort and high-grade, fixed proximal coronary atherosclerosis underwent a single saphenous vein graft to a large, dominant right coronary artery (RCA). After being asymptomatic for 1 1/2 years, she had several episodes of rest angina culminating in Prinzmetal angina and ventricular fibrillation. Electrocardiographic changes occurred in the RCA distribution. Symptoms subsided with oral nifedipine therapy. Angiography revealed intact vein graft and coronary circulation. The patient has done well for a follow-up period of 7 months.