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The syndrome of coronary artery spasm is described. This phenomenon may occur in conjunction with, or in the absence of, fixed atherosclerotic coronary artery disease. ECG manifestations during an attack mimic those seen with acute myocardial injury, but normalization of the ECG following the resolution of the pain is usual. Intravenous ergonovine is a sensitive and specific test for confirmation of the diagnosis. Nitrates and calcium channel blockers are the mainstay of therapy, although other agents are of theoretical benefit. The role of surgery is unclear.
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