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Exercise-induced ST-segment elevation possibly caused by coronary artery spasm. A case presentation and review
Insights
A patient experienced ST-segment elevation during stress testing without chest pain, potentially due to coronary artery spasm. This case highlights exercise-induced ST-segment elevation in severe coronary artery disease.
Area of Science:
- Cardiology
- Clinical Medicine
Background:
- A 36-year-old man presented with classic angina pectoris and significant ST-segment elevation (STE) in inferior leads during stress testing, despite the absence of chest pain.
- No prior history of myocardial infarction (MI) was noted, and left ventricular function was normal.
Observation:
- Coronary arteriography revealed severe obstructions in the right coronary artery (RCA) and left circumflex coronary artery (LCx).
- Left ventricular cine-angiography showed normal contractility and confirmed the absence of prior MI.
- Coronary artery bypass graft surgery to the RCA and LCx resulted in an acute transmural inferoposterolateral MI.
Findings:
- Post-surgery stress testing at 6 weeks showed resolution of the preoperative ST-segment changes.
- The patient's presentation suggests exercise-induced coronary artery spasm superimposed on severe proximal RCA stenosis.
- This spasm may have precipitated the inferior STE observed during preoperative stress testing.
Implications:
- This case underscores the potential for exercise-induced coronary artery spasm to cause significant ST-segment elevation in the context of underlying coronary artery disease.
- Understanding this phenomenon is crucial for accurate diagnosis and management of ischemic heart disease.
- The review of exercise-induced STE provides valuable insights for clinicians managing similar presentations.
Abstract:
A 36-year-old man with classic angina pectoris had marked ST-segment elevation (STE) in the inferior leads on stress-testing in the absence of chest pain. There was no evidence of previous myocardial infarction (MI). Selective coronary arteriography delineated severe obstructions in the right coronary artery (RCA) with additional left circumflex coronary artery (LCx) obstruction. Left ventricular cine-angiography established that there was normal contractility and confirmed the absence of past MI. Coronary artery bypass graft surgery to the RCA and LCx was unfortunately complicated by an acute transmural inferoposterolateral MI. Treadmill stress testing 6 weeks after surgery failed to demonstrate the preoperative ST-segment change. The patient may have developed exercise-induced coronary artery spasm superimposed on the severe proximal RCA stenosis; this in turn may have caused the inferior STE. Exercise-induced STE is reviewed.