An uncommon presentation of right ventricular ischemia and complete atrioventricular block induced by severe coronary spasm

Coronary spasm is one of the mechanisms of myocardial infarction with non fixed organic stenosis of epicardial coronary arteries. Right ventricular ischemia with High-degree AV block and coronary spasm have been reported together rarely in medical literature. This is a case of a 57-year-old man; Admitted to emergency for chest pain, ECG showed third degree atrioventricular block with ST segment elevation in inferior and right derivations, coronary angiography with methergine test revealed an ostial spasm of the right coronary from, rapidly regressive after an intracoronary injection of isosorbide dinitrate.