Isoproterenol Causing Coronary Vasospasm and ST Elevations During Tilt Table Testing

Abstract

Syncope is a sudden but reversible brief loss of consciousness secondary to an acute reduction of cerebral perfusion. Reflex syncope denotes neurologically mediated syncope, which includes vasovagal, carotid sinus syndrome, and other situational syncope. The most frequent form of syncope is vasovagal, which is triggered by emotional stress or prolonged standing, and may be diagnosed with the tilt table test. A thorough investigation of syncope is necessary as serious cardiovascular disorders may also be a cause. A tilt table test is a widely used tool utilized by clinicians to diagnose vasovagal syncope and is sometimes augmented with isoproterenol, a β-sympathomimetic that acts on the heart. This report seeks to explain a case of a 48-year-old previously healthy woman who experienced inferior wall ST elevations during tilt table test supplemented with isoproterenol. There is reason to believe that the results of this patient’s tilt table test were due to vasovagal syncope in conjunction with right coronary artery vasospasm.

Vasospastic Angina With ST-Segment Elevation Seen During Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring

“…Traditionally, most ST-segment deviations seen on remote cardiac monitoring is reported as ST-segment depressions, indicating episodes of transient ischemia. 27 - 30 These early studies hinted at the value of identifying transient ST-segment changes as valuable, particularly, as it identified patients at higher risk. 29 …”

“…Traditionally, most ST-segment deviations seen on remote cardiac monitoring is reported as ST-segment depressions, indicating episodes of transient ischemia. [27][28][29][30] These early studies hinted at the value of identifying transient ST-segment changes as valuable, particularly, as it identified patients at higher risk. 29 Aside from improvement in the quality of tracings, MCOT devices also offer the availability of continuous listening; recording every heartbeat for up to 30 days with the flexibility of storing data locally or when needed, data can be transmitted in real time for immediate assessment as seen in our case.…”

Isoprenaline induced myocardial infarction in a patient with high-grade atrioventricular block: a case report

“…However, none of the patients in this very small study reported any chest pain or shortness of breath, and the ECG changes all resolved shortly after cessation of isoprenaline. Kumar et al 9 and Duong et al 10 both reported cases of chest pain and inferior ST-elevation after isoprenaline administration. In both cases, the patient’s symptoms and ECG improved after sublingual nitroglycerine administration, and subsequent coronary angiography showed no obstructive coronary artery disease, raising the likelihood that these presentations were due to coronary spasm.…”

Reactive Oxygen Species Cause Exercise-Induced Angina in a Myocardial Ischaemia-Reperfusion Injury Model

“…Angina refers to cardiac pain or discomfort triggered by strenuous activities. Several experimental angina models, such as vasopressin-, methacholine- and isoproterenol-induced angina models, have been used for studying angina [ 16 , 17 , 18 ]. Further, several indirect indicators such as ST-segment, blood pressure, and biochemical markers of myocardial injury are used to evaluate angina [ 29 , 30 , 31 ].…”

“…Although several mechanisms, such as inflammation, apoptosis, microvascular dysfunction, and oxidative stress, are involved in I/R injury [ 15 ], the relationship of angina and I/R injury is still insufficiently understood. Even though vasopressin, methacholine, and isoproterenol, which evoke vasospasm, have been used as experimental animal models for angina [ 16 , 17 , 18 ], they have less translational potential.…”