Coronary vasospasm induced by epinephrine as presentation of variant angina

A 41-year-old-man without previous ischemic heart disease, developed a severe 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. Coronary arteriography disclosed normal coronary arteries. Eight months later, the patient developed severe chest pain during physical activity. ST elevation was again seen in inferior leads. ECG changes disappeared, when sublingual nitroglycerin was administered. A diagnosis of vasoespastic angina was made. Exercise-test was negative, during treatment with calcium blocking agents. The patient subsequently remain free of symptoms taking medication. The physiological mechanisms of vasoespastic angina and precipitanting factors are discussed.