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SUMMARY Coronary artery spasm has been recognised recently as a possible cause of perioperative myocardial ischaemia after coronary artery bypass grafting. We report on one case and review the published reports. We emphasise the clinical picture of the patient who is liable to have spasm and the necessity for a prompt diagnosis and correct treatment. (Fig. la) and all branches of the left coronary artery appeared diffusely narrowed. The vein graft was patent despite a very poor run-off (Fig. lb). Glyceryl trinitrate, 1 mg, was then administered into each coronary artery and into the graft; subsequent injections of contrast medium demonstrated the return of each vessel to its previous size, while left anterior descending artery graft appeared satisfactory (Fig. 2).Total CK and MB peaked at 576 and 38 units, respectively, on the morning of the first postoperative day. The electrocardiogram returned to baseline without any further ST change, or pathological q waves.After catheterisation, nitrates were continued at a total daily dose of 306 mg (through combined sublingual, intravenous, and percutaneous routes) which was halved after one week. There were no further episodes of angina.Six weeks after operation the patient was readmitted for elective stress testing, dynamic electrocardiography, and repeat angiography. All findings were normal, and the patency of the vein graft was confirmed. 280

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