Figure 52

A. Left coronary arteriogram (angiogram, 45 degrees LAD view with 25 degrees craniocudal angulation) of a 47-year-old man with active variant angina. A 40% proximal LAD stenosis is present. The coronary arteries are otherwise normal angiographically.
B. The control angina and ST (EKG) elevation developed spontaneously during coronary arteriography. Repeat injections reveal severe focal spasm at the site of the lesion. The coronary spasm (see definition of vaso spasm) resolved immediately after nitroglycerin (medication) administration.
C. Left coronary arteriogram in the RAO view after ergonovine (medication) administration. Severe coronary spasm is present both at the site of the LAD stenosis and distal to it.
D. Resolution of ergonovine-induced spasm following nitroglycerin administration.

Theroux, P., M.D., Waters, D., M.D., Diagnosis and Management of Patients with Unstable Angina, The Hurst's The Heart, 8th ed., p 1099. (modified)