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Exercise-induced angina with intermittent ST-segment elevation

T Inomata1, Y Igarashi, K Ebe

  • 1Division of Cardiology, Nagaoka Red-Cross Hospital.

Internal Medicine (Tokyo, Japan)
|June 1, 1995
PubMed
Summary

This rare case reveals variant angina causing reproducible chest pain and ST-segment elevations during exercise stress tests. Prompt nitroglycerin resolved the coronary artery narrowing, highlighting vasospasm as the cause.

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Area of Science:

  • Cardiology
  • Clinical Medicine
  • Diagnostic Imaging

Background:

  • Variant angina, also known as Prinzmetal's angina, is characterized by coronary artery vasospasm.
  • It typically presents with chest pain at rest, often occurring in the early morning hours.
  • Exercise-induced variant angina is less common but can mimic typical angina.

Observation:

  • A 59-year-old male presented with exertional angina, particularly in the morning.
  • Graded treadmill exercise stress testing reproducibly induced chest pains and ST-segment elevations in inferior leads (II, III, aVF).
  • Coronary angiography revealed a critical 90% stenosis in the mid-right coronary artery.

Findings:

  • The coronary narrowing was transient and completely resolved following intracoronary nitroglycerin administration.

Related Experiment Videos

  • This response strongly suggests coronary artery vasospasm as the underlying mechanism.
  • The findings indicate a rare presentation of variant angina triggered by exercise.

    • Implications:

    • This case underscores the importance of considering vasospastic angina in patients with exercise-induced ischemic symptoms and ST-segment changes.
    • Reproducible demonstration during stress testing aids in diagnosing variant angina.
    • Prompt relief with nitroglycerin confirms the diagnosis and guides management strategies for coronary artery vasospasm.