A case is reported in which multiple needles were inserted into the heart by a patient, resulting in the unusual combination of a coronary artery-cameral fistula to the left ventricle, an intramural defect of the left ventricular free wall and a ventricular septal defect. This unique lesion was suspected on the basis of two-dimensional and Doppler echocardiography and contrast computed tomographic imaging. Its presence was confirmed during cardiac catheterization and cineangiography.
Chest pain limited to the postexercise recovery period is an uncommon symptom, the clinical correlates
of which have not been previously reported. Therefore, 25 patients with chest pain limited to the postexercise
recovery period were compared to 25 patients with chest pain during treadmill exercise testing and to 25 patients
with no chest pain during exercise or recovery. Patients with chest pain during exercise or recovery had more
extensive angiographic coronary disease compared to patients without chest pain. In study patients with pain during
recovery from exercise, ST-segment depression on the exercise electrocardiogram was highly predictive for the
presence of coronary artery disease (p < 0.01). For patients with chest pain limited to the recovery period, the
rate-pressure product was significantly lower at the time of onset of chest pain compared to the time of peak exercise
(16,589 ± 6,877 versus 24,039 ± 8,020, p < 0.05). The latter findings suggest that chest pain first appearing during
recovery from exercise may not be a direct result of increased myocardial oxygen demand.
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