急性冠心症是一種嚴重之疾病，尤其是急性ST段上升心肌梗塞。急性ST段上升心肌梗塞典型呈現心電圖ST段上升、血清心肌酵素上升及心臟超音波有局部心肌活動異常。臨床上有一些情形類似急性ST段上升心肌梗塞，包括冠狀動脈痙攣、蜘蛛網膜下出血、嗜銘細胞瘤、電休克治療及心尖球型綜合症。在此我們提出一位65歲男性，因嚴重胸悶並冒冷汗及昏厥住院，冠狀動脈攝影時發現左前降支及右冠狀動脈自發性全阻塞，並有胸悶、ST段上升及低血壓情形，經冠狀動脈內注射isosorbide dinitrate後緩解，出院後病患接受口服藥物verapamil、長效型nitrate及nicorandil治療，門診追蹤期間未再發生胸悶、冒冷汗或昏厥。

Acute coronary syndrome (ACS) is a critical disease especially in case of acute ST segment elevationmyocardial infarction (STEMI). Acute STEMI typically shows ST segment elevation on electrocardiography(ECG), elevation of serum cardiac enzyme and abnormal regional wall motion on echocardiogram.However, coronary artery spasm(CAS), subarachnoid hemorrhage, pheochromocytoma, electroconvulsivetreatment, and apical ballooning syndrome1-3 can also result in similar clinical scenarios. Here, we report acase of a 65-year-old male who was admitted to our hospital because of severe chest pain associated withcold sweating and syncope. Coronary angiography (CAG) revealed spontaneous total occlusion of the leftanterior descending artery (LAD) and right coronary artery (RCA) accompanied with severe chest pain, STsegment elevation, and hypotension. The severe coronary spasms were relieved via intracoronaryadministration of isosorbide dinitrate. After discharge, the patient was treated with verapamil, oral longactingnitrate, and nicorandil. No chest pain with cold sweating or syncope occurred at OPD follow-up.