Is it a STEMI: A Unique Case of Chest Pain and Severe Coronary Vasospasm Due to COPD Exacerbation
Document Type
Conference Proceeding - Restricted Access
Publication Date
5-8-2026
Abstract
Vasospastic angina (VSA) is a syndrome of chest pain from myocardial ischemia due to transient narrowing of the coronary arteries. The prevalence is difficult to ascertain, as provocative spasm testing is not routinely performed. VSA typically presents as angina and transient ischemic electrocardiogram (ECG) changes (ST segment elevations) which can resolve with short-acting nitrates. VSA is commonly triggered by cigarette smoking, with other triggers including cocaine, emotional stress, and cold exposure. Our case highlights a unique case of a chronic obstructive pulmonary disease (COPD) exacerbation triggering suspected vasospastic angina.
A 47-year-old female with a history of peripheral artery disease, 48-pack-year tobacco use, and suspected emphysema presented to the emergency department with shortness of breath. She reported a two-week history of progressive dyspnea refractory to her albuterol inhaler along with severe palpitations accompanied by left arm numbness. She was admitted for acute respiratory failure in the setting of a COPD exacerbation, and she received broad-spectrum antibiotics and steroids.
This case highlights COPD exacerbation as a rare trigger for vasospastic angina, particularly in patients with cardiovascular risk factors. Recognition and prompt initiation of primary therapy with optimization of respiratory status, along with calcium-channel blockers, led to symptom resolution. While COPD exacerbations are well established triggers for type two myocardial infarctions, vasospastic angina with profound ST segment elevations has been rarely reported. This underscores the need for further research and vigilance for coronary vasospasm in COPD patients.
Recommended Citation
Day E, Hakim L, Mrozek M, Ocomen R, Hollowell M, Joseph T. Is it a STEMI: A unique case of chest pain and severe coronary vasospasm due to COPD exacerbation. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.
Comments
2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2031