Asymptomatic coronary artery spasm with acute pathological ST elevation on routine ECG: Is it common?

Mohammed, Ishaq; Zaatari, Mohamad Sadek El; Tyrogalas, Nikos; Khalid, M I

doi:10.1136/bcr-2013-202586

Cited by 3 publications

(4 citation statements)

References 11 publications

(13 reference statements)

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“…However, in our case, the coronary spasm was driven by a non-atherosclerotic event which means that the underlying factor that contributed to this event needs to be investigated further. According to Muhammed, I et al, (2014) [3] and Ertan C et al, (2017) [8] CAS do not always present with ECG changes however, this was not similar with the findings of our case as ECG changes were recorded in our patient. STsegment changes were recorded in leads aVL, V1 V2 and V3 in our patient before treatment.…”

Section: Discussioncontrasting

confidence: 86%

“…Coronary Artery Spasm (CAS) or Coronary Vasospasm is a critical non-atherosclerotic event that if not treated promptly can progress to a deadly condition like MI or even sudden death. It is characterized as the sudden, intense vasoconstriction of an epicardial coronary artery that may result in partial or complete vessel occlusion [3]. The pathological mechanisms that contribute to CAS include endothelial dysfunction, vascular smooth muscle cells and other microvascular dysfunction [4].…”

Section: Introductionmentioning

confidence: 99%

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A Case Report of Non-Atherosclerotic Driven Myocardial Infarction in a Patient Presenting with Coronary Artery Spasm

Tariq

Akhtar

Yaqub

et al. 2021

PBMJ

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Background: Non-atherosclerotic processes are regarded as equally important contributors to a substantial number of coronary problems mainly myocardial infarction. This includes coronary spasm which has been considered as one of the coronary syndromes leading to myocardial infarction. These non-atherosclerotic events ensuing in major averse cardiac events (MACE) not only require various diagnostic and therapeutic strategies but also there is a need to delineate the underlying etiology for their effective treatment and management. Case Summary: We report a case of anterior wall myocardial infarction (AWMI) driven by a non-atherosclerotic event i.e. coronary spasm. Concomitant marked ST-segment elevation recorded on ECG revealed a diffuse mid distal disease in our patient. We report here the initial presentation, coronary care & intervention and throughout the clinical course of our patient. Conclusion: Myocardial infarctionsinvolving non-atherosclerotic causes in young individuals as in our study should be reported by medical practitioners and given equal importance as they might indicate the underlying root cause of such events. Effective treatment of such future cases can be done by taking management strategies, diagnostic findings and prognostic data into consideration.

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Section: Discussioncontrasting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

A Case Report of Non-Atherosclerotic Driven Myocardial Infarction in a Patient Presenting with Coronary Artery Spasm

Tariq

Akhtar

Yaqub

et al. 2021

PBMJ

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“…Coronary vasospasm usually presents with chest pain and ECG changes; the absence of chest pain, despite gross ECG changes, is unusual. There is one case report of an incidental finding of ST elevation without any symptoms, although that patient was older and had a prior medical history of hypertension and hypercholesterolaemia 11. Asymptomatic ST elevation has been reported in patients with coronary vasospasm.…”

Section: Discussionmentioning

confidence: 99%

ST elevation in recovery post exercise with normal coronary arteries

et al. 2019

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We present the case of a 45-year-old healthy man who successfully completed three stages of the Bruce protocol but developed inferolateral ST segment elevation in the recovery phase. The ECG change was associated with a marked drop in blood pressure. He underwent emergency coronary angiography which revealed normal coronary arteries. It is likely that post-exercise hypotension triggered coronary spasm which caused the ST segment elevation. Alternatively, coronary spasm may have been the primary event, inducing sufficient myocardial ischaemia to cause a marked drop in blood pressure. Exercise tolerance testing is often a reliable test to rule out reversible myocardial ischaemia. While the physician is focused on ischaemic changes or rhythm abnormalities developing during the exercise phase, the recovery period is just as important and requires as much vigilance. Coronary vasospasm can result in significant ST changes and haemodynamic compromise at any point during the test, and the ECG traces can be indistinguishable from a classic ST elevation myocardial infarction, as in the present case.

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“…Mohammed et al . 7 reported a case of coronary vasospasm in a patient presenting with ST elevation on ECG and no chest pain. Coronary angiography showed no evidence of coronary vasospasm although provocation testing was not undertaken to confirm the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

The role of computed tomography coronary angiography in multi-vessel coronary vasospasm: a case report

Tomlinson

Patel

Levy

2021

European Heart Journal - Case Reports

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Background Coronary vasospasm can present like an acute coronary syndrome (ACS) with an intense vasoconstriction resulting in total or near-total occlusion of one or more of the coronary vessels. Definitive diagnosis can be made by intracoronary provocation testing. Case summary A 37-year-old Caucasian male and smoker was admitted with chest pain. Highly sensitive troponin-I was positive at 63 ng/L (99th percentile upper reference limit, <15 ng/L) with a repeat value of 45 ng/L three and a half hours later which was of clinical significance. Serial electrocardiography (ECG) showed no ischaemic changes. Coronary angiography revealed several distal and side branch stenoses; however, angiographic appearances were atypical of coronary plaque. A differential diagnosis of spontaneous coronary artery dissection was suspected although the patient was pain free during the procedure. Computed tomography coronary angiography (CTCA) demonstrated normal coronary arteries, confirmed on repeat invasive coronary angiography. Cold pressor testing was unsuccessful in reproducing vasospasm. Acute coronary syndrome treatment was discontinued, he received smoking cessation advice and Amlodipine 5 mg daily was started. He has experienced no further episodes of cardiac chest pain on follow-up consultation 7 months later. Discussion This is an unusual case of persistent, extensive coronary vasospasm in a patient without ongoing chest pain or ischaemic ECG changes. Intracoronary nitrates are usually effective at relieving coronary spasm. Cold pressor testing has poor sensitivity for diagnosing vasospasm when compared to intracoronary provocation testing using either acetylcholine or ergonovine. Multi-slice CTCA may help to discriminate coronary plaque from coronary vasospasm when there is diagnostic uncertainty.

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Asymptomatic coronary artery spasm with acute pathological ST elevation on routine ECG: Is it common?

Cited by 3 publications

References 11 publications

A Case Report of Non-Atherosclerotic Driven Myocardial Infarction in a Patient Presenting with Coronary Artery Spasm

A Case Report of Non-Atherosclerotic Driven Myocardial Infarction in a Patient Presenting with Coronary Artery Spasm

ST elevation in recovery post exercise with normal coronary arteries

The role of computed tomography coronary angiography in multi-vessel coronary vasospasm: a case report

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