• Hui Cai, Shuxia Chen, and Dongxiao Wang.
• Department of Cardiology, Hebei General Hospital, Hebei North University, Shijiazhuang, Hebei Province, China.
• Medicine (Baltimore). 2024 Jan 12; 103 (2): e36889e36889.

RationaleDiffuse multivessel coronary artery spasm (DMV-CAS) was defined as a severe and reversible diffuse spasm occurring in more than 2 major coronary arteries, which is rare in clinical practice. Due to a wide lesion scope, DMV-CAS often occurs in the form of complications. It is not easy to be clinically diagnosed because it is too brief to be caught. Here, we report a rare case of spontaneous subtotal occlusion of 3 major coronary arteries induced by Vasalva action, which was confirmed in real-time by CAG.Patient ConcernsA 68-year-old man had sudden chest pain after forced defecation during hospitalization. The electrocardiogram showed transient ST segment elevation of the inferior wall lead, inversion of the anterior wall, and lateral wall leads T waves. Emergency CAG revealed elongated vessel beds in 3 coronary arteries and multiple diffuse stenosis, but none of the coronary arteries were completely occlusive.DiagnosesDiagnoses of DMV-CAS were made based on CAG findings and postmedication response.InterventionsNitroglycerin was administered in the coronary arteries. The anti-vasospasm, antiplatelet aggregation and lipid-regulating drugs were administered orally.OutcomesThe patient was discharged on the 7th day with complete resolution of symptoms and normalization of the electrocardiography findings. No ischemic events occurred during a follow-up for 5 months.LessonsThis case highlights the identification of multivessel diffuse coronary spasm and acute myocardial infarction, and the prevention of CAS triggers, which requires the attention of clinicians.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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