A Case Report in Cardiology and Critical Care Medicine - An Extremely Rare Presentation Nitroglycerine-Responsive Combined ST-Segment Coronary Artery Spasms of High Lateral, Inferior, and Septal Affection; A Case Report

Rationale: Coronary artery spasm is common ischemic heart disease. It is a serious clinical cardiovascular issue. Nitrates such as nitroglycerine have a pivotal role in the management of coronary artery disease. Patient concerns: A 45-year-old married, officer, heavy smoker, Egyptian male patient presented with acute excruciating severe chest pain and combined electrocardiographic ST-segment coronary artery spasms. Diagnosis: Combined ST-segment coronary artery spasms of ST-segment elevations and ST-depressions was the most probable diagnosis. Interventions: Electrocardiogram, echocardiography, and nitroglycerine intravenous infusion. Outcomes: Dramatic response of both clinical and electrocardiographic combined ST-segment coronary artery spasms to nitroglycerine. Lessons: A combined ST-segment coronary artery spasms including ST-segment elevation and ST-depression may be present the same ECG. The dramatic efficacy on later using nitroglycerine in the management of combined ST-segment coronary artery spasms. Abbreviations CAS: Coronary artery spasm; ECG: Electrocardiogram; ICU: Intensive Care Unit; NSR: Normal Sinus Rhythm; O2: Oxygen; STEMI: ST-segment elevation myocardial infarction.