Despite its potential to cause severe and life-threatening complications, coronary artery spasm remains an underdiagnosed clinical condition. We present the case of a kidney transplant recipient treated with tacrolimus, which illustrates the need to consider coronary vasospasm as a differential diagnosis in ischemic heart disease, particularly when there is a mismatch between the clinical presentation and angiographic findings. The patient experienced recurrent angina, at times associated with hemodynamic instability, episodes of asystole, and transient loss of consciousness. These symptoms were attributed to diffuse spasm of the epicardial coronary arteries, most likely triggered by tacrolimus. Clinical stabilization was achieved only after modifying the immunosuppressive regimen and introducing coronary vasodilator therapy. This case emphasizes the importance of recognizing coronary vasospasm as a potential etiology in atypical presentations of myocardial ischemia, especially in younger patients and those with complex comorbidities.
Krupnikovic et al. (Wed,) studied this question.