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Prinzmetal's variant angina or vasospastic angina is produced by transient spasm of the epicardial coronary arteries, with or without significant atherosclerotic lesions. It is a disease with a wide clinical spectrum of ischemic syndromes and, sometimes, the first and only manifestation may be life-threatening arrhythmias, such as polymorphic ventricular tachycardia, ventricular fibrillation, high-grade atrioventricular block, asystole and sudden cardiac death. The concomitant presence of vasospastic angina and fixed coronary stenosis has a worse prognosis. We present a patient with distal right coronary artery spasm over an angiographically moderate atherosclerotic lesion with recurrent syncopal episodes associated with high-grade atrioventricular block. [ABSTRACT FROM AUTHOR]