Coronary vasospasm induced by epinephrine as presentation of variant angina

A 41-year-old-man without previous ischemic heart disease, developed a seve re anaphylactic reaction. After administration of epinephrine (0.5 mg) the patient complained of chest pain. The electrocardiogram showed an elevation of ST-segment in inferior leads. Myocardial necrosis was ruled out. Corona ry arteriography disclosed normal coronary arteries. Eight months later, th e patient developed severe chest pain during physical activity. ST elevatio n was again seen in inferior leads. ECG changes disappeared, when sublingua l nitroglycerin was administered. A diagnosis of vasoespastic angina was ma de. Exercise-test was negative, during treatment with calcium blocking agen ts. The patient subsequently remain free of symptoms taking medication. The physiological mechanisms of vasoespastic angina and precipitanting factors are discussed.