Acute Psychological Stress, Coronary Artery Spasm, Iatrogenic Coronary Dissection, In-stent Restenosis, and Atherosclerosis: A Rare Association of Multiple Etiologies for Recurrent Acute Coronary Syndrome

Abstract

Nonobstructive coronary artery lesions are seen in two-thirds of patients with angina and verified ischemia using a stress test who undergo coronary angiography. Ischaemia with no obstructed coronary artery disease (INOCA) is becoming more well recognized as a significant medical illness due to its relationship to decreased quality of life and an increased risk of cardiac events. This association between acute coronary syndrome (ACS) and high levels of psychological stress has been thoroughly investigated, and it has been found to be substantial. The microvascular function of the coronary arteries is endothelium-dependent, and this plays a role in how the heart reacts to psychological stress. Although coronary artery spasm (CAS) is likely to play a role in the etiology of INOCA, it is frequently misdiagnosed and underreported. In this article, we discuss a case of a young woman who came with recurrent ACS related to CAS, which was exacerbated by iatrogenic coronary dissection due to the presence of arteria lusoria, an atherosclerotic coronary artery disease leading to in-stent restenosis of the previous stent.