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Published on: May 28, 2019
A case report of Brugada-like ST-segment elevation probably due to coronary vasospasm
Lu Yang1, Guodong Ma, Tianyu Yu
1Department of Cardiology, Beijing Friendship Hospital Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China.
Insights
This case report details a patient with vasospastic angina presenting with Brugada-like ST-segment elevation. The findings suggest a potential link and shared mechanisms between these cardiac conditions.
Area of Science:
- Cardiology
- Electrocardiography
- Cardiac Electrophysiology
Background:
- Vasospastic angina involves epicardial artery vasoconstriction causing ST-segment elevation.
- Brugada Syndrome is an inherited disorder with characteristic ST-segment elevation in V1-V3.
- These conditions are typically unrelated.
Observation:
- A patient presented with symptoms suggestive of vasospastic angina.
- Electrocardiography revealed Brugada-like ST-segment elevation.
- Coronary angiography confirmed vasospastic angina.
Findings:
- The patient's electrocardiography mimicked Brugada Syndrome despite a vasospastic angina diagnosis.
- Treatment included diltiazem, aspirin, isosorbide mononitrate, and rosuvastatin, with lifestyle change advice.
- A six-month follow-up showed positive outcomes.
Implications:
- This case suggests a potential link between Brugada Syndrome and coronary vasospasm, possibly sharing underlying mechanisms.
- Distinguishing between these conditions may require provocation and genetic testing.
- Long-term monitoring is crucial for identifying risks of life-threatening ventricular arrhythmias.
Rationale:
Vasospastic angina is caused by sudden occlusive vasoconstriction of a segment of an epicardial artery, with transient ST-segment elevation on electrocardiography. Brugada Syndrome is an inherited arrhythmogenic cardiac disorder with a diagnostic electrocardiography characterized by coved-type ST-segment elevation in right precordial leads (V1-V3). Those two diseases usually have no correlation. In this report, we discuss an interesting case of a patient who was diagnosed as vasospastic angina according to his coronary angiography, but his electrocardiography showed a Brugada-like ST-segment elevation.
Patient Concerns:
Our patient had a 9-month history of temporary but progressive substernal burning sensation with acid bilges of shoulders and arms, as well as profuse sweating at night.
Diagnoses:
Although he had no abnormal laboratory test result, no dysfunctional recorded echocardiogram or documented arrhythmia after being admitted to the hospital, his electrocardiography showed a Brugada-like ST-segment elevation. The coronary angiography result confirmed a diagnosis of vasospastic angina.
Interventions:
The patient was prescribed diltiazem, aspirin, isosorbide mononitrate and rosuvastatin and was strongly advised to quit cigarettes and alcohol.
Outcomes:
Follow-up at half a year turned out well.
Lessons:
This case links Brugada syndrome to coronary vasospasm. They may share similar mechanisms. Provocation test and gene test needs to be ran to distinguish both. Long-term follow-up is essential for it may bring a warning sign for life threatening ventricular arrhythmias.
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