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A previously healthy 36-year-old male was admitted with acute onset chest pain and elevated levels of cardiac enzymes (CK/MB 248/25ng/dl and TnI 7.16ng/dl). He denied use of cocaine or other illicit drugs. Clinical history was negative for recent flu-like syndrome. Physical examination is unremarkable. ECG showed Q wave in lead III with T wave inversion (Figure 1A). An echocardiogram showed a structurally normal heart with no wall motion abnormalities. He had the abrupt recurrence of severe chest discomfort 12 hours later associated with ST segment elevation in I and aVL (Figure 1B). Symptoms were relieved after administration of intravenous nitroglycerin and ECG changes suddenly resolved. Urgent coronary angiography revealed normal coronary arteries, despite slow flow in the left anterior descending artery. The patient was diagnosed with AMI type 2 secondary to probably coronary artery spasm.
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