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Updated: May 4, 2026

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Published on: April 4, 2022
Complete sustained reversal of cyclic ST-segment elevation (coronary cyclic flow variations) by low-dose intravenous
Matteo Azzarone1, Andrea Fasulo1, Chiara Leuzzi1
1Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
Background:
Recurrent ST-segment elevations in acute coronary syndromes have been attributed to coronary cyclic flow variations (CCFVs) possibly due to coronary vasospasm and unstable platelet aggregation in partially occluded arteries.
Methods:
We describe the case of a patient with an acute myocardial infarction, recurrent ST-segment elevations and diffuse disease of the left anterior descending artery.
Results:
The post-angiography 12-lead continuous ECG monitoring revealed cyclic anterior ST-segment elevations that were completely abolished with continuous intravenous infusion of low-dose isosorbide-dinitrate.
Conclusion:
The complete and sustained response to low-dose nitrate suggests that vasoconstriction plays a crucial role to provoke CCFVs. This case underlines the importance of continuous 12-lead ECG monitoring with ST-segment trend analysis in the CCU.
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