Curing the incurable: a case of refractory vasospastic angina

Vasospastic angina (VSA) is the spasm of coronary arteries causing transient myocardial ischemia. VSA is commonly managed with antispasmodic medications including calcium-channel blockers (CCB) and nitrates. When vasospasm is refractory to conventional medications, unconventional treatment modalities may be used for symptomatic relief (Tandon et al., 2019 Feb) [1]. There are several mediators of vasospasm, with serotonin playing a major role. Serotonin is a product of platelet aggregation and has multiple effects on the endothelium, which forms the basis of an unconventional treatment modality that may be used for symptomatic relief of VSA. In this case, a 44 year old female with a history of coronary artery disease (CAD) status post coronary artery bypass graft (CABG) with recent drug-eluting stent (DES) placement was admitted for shortness of breath and chest pain, found to have a positive stress echocardiogram (Echo), and had unremarkable coronary angiography. Given persistent symptoms while on optimal medical therapy and with negative coronary angiography, the diagnosis of refractory VSA was made. Patient was started on a serotonin receptor blocker with improvement of her symptoms.