Rationale: Tetany is a common, serious, well-established endocrinal and metabolic hypocalcemic disorder. Chest tetany is a novel metabolic term in hypocalcemia characterized by acute severe twisting chest pain.Movable phenomenon (Yasser’s phenomenon) is a new phenomenon that is usually associated with hypocalcemia. oxygenationmay have a role in the management of coronary artery spasm.

Patient concerns: A middle-aged farmer smoker male patient presented to physician outpatient clinic with tetany,mimic high lateral myocardial infarction, mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary artery spasm.

Diagnosis: Mimic high lateral myocardial infarction in chest tetany with mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary artery spasm.

Interventions: Electrocardiography, oxygenation, IVcalcium injection, and echocardiography.

Outcomes: Acute dramatic clinical and electrocardiographic improvement had happened.

Lessons: The reversal of mirror electrocardiographic change, reversal of ST-segment depression coronary artery spasm, and normalization of Movable phenomenon (Yasser’s phenomenon) after oxygenation. It signifies the role of oxygen in both coronary artery spasm and tetany. Mirror local electrocardiographic change is a novel described expression that may reflect the myocardial polarity in this chest tetany.

Keywords: Mimic high lateral myocardial infarction, Chest tetany, Mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), Coronary spasm, Oxygen reversal

Abbreviations: CAS: Coronary artery spasm, D1: First diagonal branch, ECG: Electrocardiography, HL-STEMI: High lateral ST-segment elevation myocardial infarction, IHD: Ischemic heart disease, MI: Myocardial infarction, NSR: Normal sinus rhythm, O2: Oxygen, PG: Prostaglandin, POC: Physician outpatient clinic, SAF: South African flag, STEMI: ST-segment elevation myocardial infarction,TXA2: Thromboxane A2, VR: Ventricular rate