A 50-year-old man with a long-term history of smoking and heavy alcohol consumption presented with a 2-year history of recurrent upper abdominal pain and syncope following alcohol intake

which had progressively worsened. The episodes typically occurred 6~20 hours after drinking

lasted approximately 5~10 minutes

and syncope was associated with heavy alcohol consumption. The 24-hour holter during symptoms revealed transient ST-segment elevation in the inferior leads accompanied by high-grade atrioventricular block. In another documented episode

there was extensive ST-segment elevation involving both the inferior and anterior leads

with short runs of ventricular tachycardia. Coronary angiography showed only mild (approximately 10%) stenosis in the proximal left anterior descending and right coronary arteries

without significant atherosclerotic lesions elsewhere. Based on the clinical course and dynamic electrocardiography changes

a diagnosis of alcohol-induced Prinzmetal's variant angina due to coronary artery spasm

complicated by malignant arrhythmia was established. The patient was treated with diltiazem for prevention of coronary spasm

in addition to statin therapy and dual antiplatelet agents

along with strict cessation of smoking and alcohol. During a 2-year follow-up

there was a complete resolution of symptoms. This case indicates that coronary artery spasm should be strongly considered in patients who develop chest or upper abdominal pain and syncope within 24 hours of alcohol consumption

and that timely recognition and targeted intervention may result in a favorable prognosis.