A 50-year-old male presents to the emergency department with episodes of chest pain occurring over the past few weeks. He describes the pain as a tight, squeezing sensation in the center of his chest, typically occurring at rest and lasting about 10 to 15 minutes. The episodes often happen in the early morning hours or at night and are sometimes accompanied by shortness of breath and sweating. He denies any pain during physical exertion. The chest pain resolves spontaneously and has not been triggered by exercise.

His medical history includes hypertension, which is well controlled with medication, and a 20-year smoking history, though he quit smoking two years ago. He does not have a history of coronary artery disease, diabetes, or recent illnesses. Physical examination is unremarkable, and his vital signs are stable.

An electrocardiogram (ECG) performed during one of his chest pain episodes shows transient ST-segment elevation, but a follow-up ECG and cardiac enzyme levels are normal. A coronary angiogram reveals no significant coronary artery blockage. The patient is diagnosed with variant angina (Prinzmetal’s angina), likely caused by coronary artery vasospasm.

He is started on calcium channel blockers and a nitrate to prevent coronary vasospasms. He is advised to avoid smoking and other potential triggers. The patient is scheduled for regular follow-up to monitor his response to treatment and assess for any potential complications.