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Exploring the ECG "6+2" Phenomenon in Coronary Artery Disease and Coronary Artery Spasm: A Case Report Analysis and
Hongyang Zhang1,2, Peng Wang2, Zhen Duan2
1Department of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan, China (mainland).
Insights
This case report details a 72-year-old man with coronary artery spasm (CAS) presenting with a rare electrocardiogram (ECG) "6+2" phenomenon. This finding, typically associated with significant coronary artery disease, was observed in a patient with normal coronary angiography results, highlighting a unique presentation of CAS.
Area of Science:
- Cardiology
- Diagnostic Electrocardiography
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) and coronary artery spasm (CAS) can both cause acute myocardial infarction but require distinct treatment strategies.
- The electrocardiogram (ECG) "6+2" phenomenon is a recognized indicator of left main or multi-vessel coronary artery disease.
- There are no prior reports of the ECG "6+2" phenomenon in patients with CAS.
Observation:
- A 72-year-old male with a history of recurrent chest pain presented with acute chest pain at rest.
- Emergency ECG revealed the "6+2" phenomenon with significantly elevated troponin levels.
- Coronary angiography showed no significant coronary artery stenosis, leading to a suspicion of CAS.
Findings:
- The patient was diagnosed with coronary artery spasm (CAS) despite normal coronary angiography findings.
- The ECG "6+2" phenomenon, usually linked to severe CAD, was observed in this CAS case.
- ECG findings normalized after medical intervention for CAS.
Implications:
- This case expands the understanding of ECG manifestations in CAS, presenting a novel association with the "6+2" phenomenon.
- Differentiating CAS from atherosclerotic coronary artery disease is critical for appropriate treatment and patient outcomes.
- Coronary angiography remains essential for accurate diagnosis and guiding targeted interventions in suspected CAS cases.
Abstract:
BACKGROUND Although coronary artery disease and coronary artery spasm (CAS) can lead to acute myocardial infarction, there are clear differences in treatment between coronary heart disease and CAS, and the therapeutic schedule should not be confused. Furthermore, electrocardiogram (ECG) "6+2" phenomenon is recommend as a specific ECG indicator for lesions in the left main coronary artery or multiple vessels. Currently, no reports of this phenomenon in CAS exist. CASE REPORT A 72-year-old man had history of recurrent chest pain for over 6 years, with episodes lasting about 10 min and resolving with rest. He experienced symptom recurrence and exacerbation due to substance abuse. He was admitted to our Emergency Department for chest pain at rest. His emergency ECG revealed a 6+2 phenomenon, accompanied by troponin levels exceeding 18 times the reference value. Promptly, we conducted coronary angiography, with unexpected normal findings. Following thorough assessment, we postulated the patient could have CAS. Subsequent to medical team intervention, the patient's ECG normalized, leading to his discharge upon condition stabilization. CONCLUSIONS We report a case of CAS in a patient with ECG 6+2 phenomenon, without significant coronary artery stenosis. This differs from transient ST-segment elevation on ECG, a well-recognized hallmark of CAS; however, such a presentation has not been documented before. Additionally, treatment strategies for myocardial ischemic conditions stemming from coronary atherosclerosis diverge from those employed for CAS. Therefore, clinicians should advocate for coronary angiography whenever feasible. This approach serves to elucidate the underlying disease etiology and facilitates the administration of precision-targeted interventions for patients.
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