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A 66-year-old woman with prolonged chest pain
  1. Mathieu Lempereur,
  2. Nigussie Bogale,
  3. Anthony Fung
  1. Department of Cardiology, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Mathieu Lempereur, Vancouver General Hospital, 2775 Laurel St, 9th Floor, Vancouver, British Columbia, Canada V5Z 1M9; matlempereur{at}

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Clinical introduction

A 66-year-old woman presented with prolonged chest pain at rest. ECG showed poor R-wave progression with T-wave inversion anteriorly (online supplementary figure S1). Serum troponin I peaked at 29 μg/L (normal <0.05 μg/L). Coronary angiography was pursued: the left coronary artery system is shown following injection of intracoronary nitroglycerin (figure 1A, B).

Figure 1

Angiographic left anterior oblique (LAO) cranial view of left coronary system during diastole (A) and systole (B). Intravascular ultrasound of the left anterior descending artery (C).


Which of the following is the next best step in management?

  1. calcium channel blocker therapy for coronary spasm

  2. coronary stenting for revascularisation of plaque …

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  • Contributors All authors have participated in the work and have reviewed and agreed with the content of the article. AF is responsible for the overall content as guarantor.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.