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Exercise-induced ST-segment elevation possibly caused by coronary artery spasm. A case presentation and review
South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde
|September 14, 1985
Summary
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.