Differential Diagnosis

The patient's symptoms of spasms during angiography without ST elevations can be attributed to various cardiac conditions. Here's a categorized differential diagnosis:

• Single most likely diagnosis
  • Vasospastic Angina (Prinzmetal's Angina): This condition is characterized by transient coronary artery spasm, which can cause chest pain and spasms during angiography. The absence of ST elevations does not rule out this diagnosis, as the spasms can be intermittent and may not always lead to significant ischemia.
• Other Likely diagnoses
  • Microvascular Angina: This condition involves abnormal vasodilation of the microvasculature, leading to reduced blood flow and potential spasms. It may not always present with ST elevations.
  • Cardiac Syndrome X: This condition is characterized by chest pain and normal coronary arteries on angiography. Spasms can occur, and ST elevations may not always be present.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Acute Coronary Syndrome (ACS) with Non-Obstructive Coronary Artery Disease: Although the patient does not have ST elevations, it is essential to consider ACS, especially if there are other symptoms or risk factors present.
  • Aortic Dissection: This life-threatening condition can cause chest pain and spasms, and it is crucial to rule it out, even if the presentation is atypical.
• Rare diagnoses
  • Coronary Artery Embolism: This rare condition can cause coronary artery spasm and ischemia. It is essential to consider it, especially if there are no other obvious explanations for the patient's symptoms.
  • Kounis Syndrome: This rare condition involves allergic reactions that cause coronary artery spasm. It is essential to consider it, especially if there are any allergic symptoms or triggers present.