Thyrotoxicosis Related Coronary Artery Spasm Presenting as Acute Coronary Syndrome

Coronary artery spasm (CAS) is the most common diagnosis in patient with non-obstructive coronary artery disease (INOCA). CAS has a great relation with the thyrotoxicosis. It leads to severe reversible coronary vasoconstriction with wide varieties of symptoms from just simple chest pain to sudden cardiac death. Many trials and investigations are still going on to reveal the pathophysiology and the mechanism. The symptoms may mimic acute coronary syndrome so the corner stone in the diagnosis is the coronary angiography, as the use of intracoronary nitroglycerin can relieve the spasm. Other patients can be their initial presentation as cardiac arrest who have been confirmed as having coronary spasm. The possible mechanisms of coronary occlusion with thyrotoxicosis include significant direct damage duo to sensitization of the coronary arteries related to the thyrotoxic state, higher chance of atherosclerotic events, hypermetabolic state and causes imbalance between blood supply and oxygen demand, resulting in cardiac symptoms. We investigated a 41 years old lady, with no known past medical history presented with cardiac chest pain for the first time. Our analysis showed strong correlation between thyrotoxicosis and the coronary spasm. Intracoronary nitrate injection leads to relieve of the spasm. No coronary obstruction detected.