Abstract
Coronary artery spasm (CAS), a known cause of myocardial ischemia that can present as variant angina, is primarily triggered by intraoperative catheter manipulation. Evidence for a genetic predisposition to coronary artery spasm is scarce. This report describes a case involving identical twins with no conventional cardiovascular risk factors who successively developed CAS. Their coronary angiograms showed spontaneous spasm in left main coronary artery, left circumflex branch artery and left anterior descending artery. This case provides clinical evidence for a genetic predisposition to CAS, highlighting the critical need for familial screening-particularly the proactive screening of the other twin when one monozygotic twin is diagnosed with vasospastic angina.