When SVT is Not Benign: Troponin Elevation Revealing Coronary Vasospasm, A Case Report

Troponin elevation is frequently observed in patients presenting with supraventricular tachycardia (SVT) and is commonly attributed to transient demand ischemia. However, its clinical significance remains uncertain, and alternative mechanisms such as coronary vasospasm may be underrecognized.

We report the case of a 77-year-old male presenting with a first episode of SVT, successfully terminated with adenosine. Adenosine successfully restored sinus rhythm with partial regression of the ischemic ST-segment changes. Initial high-sensitivity troponin was elevated but demonstrated a significant rise on the following day, accompanied by new T-wave inversions in the lateral leads. Given the dynamic electrocardiographic changes and biomarker progression, coronary angiography was performed, revealing coronary vasospasm of the left anterior descending artery without obstructive coronary disease. The spasm resolved with intracoronary nitroglycerin administration, suggesting the diagnosis of coronary vasospasm.

Coronary vasospasm should be considered in patients with SVT and evolving troponin elevation, particularly when accompanied by dynamic electrocardiographic changes. Recognition of this mechanism is essential, as it has important diagnostic and therapeutic implications and requires a tailored management approach.