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Exercise-induced vasospastic angina with prominent ST elevation: a case report.

ABSTRACT: Background:Exercise-induced vasospastic angina (VSA) is a relatively uncommon clinical scenario but may be fatal if not appropriately managed. Case summary:A 56-year-old male patient presented to our hospital for chest oppression on exertion for a 2-week duration. The symptom arose while he was riding a bicycle in the morning but did not arise at rest or on exertion in the afternoon. He was an ex-smoker with a history of hypertension and a family history of sudden death. A resting electrocardiogram (ECG) was normal, and echocardiogram revealed no wall motion abnormalities. Coronary computed tomography angiography indicated a possible stenotic lesion in the circumflex branch. Thus, hospitalization was arranged, and transcatheter coronary angiography (CAG) was performed. In CAG, there was only mild stenosis with small perfusion area in the obtuse marginal branch. A treadmill exercise test was performed the following day to assess the contribution of cardiac ischaemia to his chest symptom on exertion. At 10 metabolic equivalents, he suddenly developed chest pain and prominent ST elevation in leads II, III, aVF, and V2-5 was noted on ECG. The test was immediately terminated, and nitrates were administered. The symptom disappeared, and the patient's ECG normalized, confirming the diagnosis of exercise-induced VSA. Another treadmill exercise test was performed 6?days after vasodilators were started. Even at maximum exercise intensity, neither chest symptoms nor ischaemic changes occurred. The patient was discharged, and the chest symptoms have not returned. Discussion:This case highlights the importance of appropriate diagnosis and management of exercise-induced VSA.

SUBMITTER: Tamura A

PROVIDER: S-EPMC6426112 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Exercise-induced vasospastic angina diagnosed with a hand grip test in the catheterization laboratory: a case report.

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Successful detection of supraventricular tachycardia following ST elevation due to vasospastic angina using an insertable cardiac monitor in a patient with recurrent syncope: a case report.

Project description: Not available

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Refractory vasospastic angina in a patient with fibromuscular dysplasia: A case report.

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Ventricular fibrillation associated with vasospastic angina pectoris in Fabry disease: a case report.

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Healed plaque erosion as a cause of recurrent vasospastic angina: a case report.

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A case of vasospastic angina with exertional sign.

Project description:We herein report a case of a 56-year-old woman with angina pectoris. She visited our emergency room because of chest pain. She finally underwent emergency percutaneous coronary intervention in right coronary artery due to acute coronary syndrome. Several months later, she complained of exertional chest pain again. Exercise-stress electrocardiogram showed ST-segment depression in V2-V6. However, coronary angiography showed no organic stenosis and we conducted acetylcholine provocation test. We finally detected severe coronary artery spasm and diagnosed exercise-induced vasospastic angina (VSA). This case highlights the importance of the recognition of exercise-induced VSA. Exercise-induced VSA needs the definite diagnosis and appropriate treatment. Learning objective Many patients felt chest pain even if they have undergone percutaneous coronary intervention (PCI). This case highlights the importance of the recognition of exercise-induced vasospastic angina (VSA). Exercise-induced VSA needs definite diagnosis and appropriate treatment. This case report describes the importance of precise diagnosis and highlights the recognition of exercise-induced VSA. We recommend the acetylcholine provocation test after PCI in order to determine the diagnosis of exercise-induced VSA.

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Treatment of refractory vasospastic angina complicated by acute pulmonary oedema with levosimendan: a case report.

Project description:BackgroundVasospastic angina (VA) is an important cause of chest pain and patients often have 3- to 6-month clusters of recurrent attacks, separated by relatively asymptomatic periods. During these episodes the resulting myocardial ischaemia can lead to clinical complications of different severity, including acute myocardial infarction, acute heart failure, and cardiogenic shock. The management of severe and recurrent VA attacks is challenging, and no specific recommendations exist in recent cardiologic guidelines on the pharmacological strategy (inotropic/vasopressor agents) to adopt for this acute clinical setting.Case summaryWe present a case of recurrent episodes of VA complicated by acute pulmonary oedema and cardiogenic shock despite maximal tolerated therapy (intravenous calcium antagonist and nitrates) that was successfully treated with levosimendan.DiscussionLevosimendan rapidly reverted cardiogenic shock, acute pulmonary oedema, and mitral regurgitation caused by a refractory coronary spasm, contributing to persistent clinical stabilization. Further evidence and a longer follow-up are needed to support our observation on the efficacy of levosimendan in this specific clinical setting.

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Uncommon ascaris induced eosinophilic myocarditis simulating acute coronary syndrome without ST segment elevation: A case report.

Project description:Introductionand importance: Ascaris lumbricoides is a nematode parasite that causes ascariasis. Cardiac involvement in ascariasis is uncommon and rarely reported in the literature.Case presentationWe present the case of 45 years-old man, with previous medical history of ascaris infection one week before his admission to the emergency department for acute chest pain. The electrocardiogram revealed ST-segment and T wave abnormalities in septo-apico-lateral and inferior leads, along with high levels of troponin T and eosinophil blood cells count, while transthoracic echocardiography showed lateral and inferior walls motion abnormalities. The diagnosis of myocardial infarction was made and an urgent coronary angiography was carried out revealing normal coronary arteries which redressed the diagnosis and supported ascaris induced eosinophilic myocarditis (EM). The patient was put under anthelmintic drugs with favorable clinical, biological and imaging evolution.Clinical discussionEosinophilic myocarditis may present with variable and misleading scenarios ranging from asymptomatic patients to cardiogenic choc and sudden death and in some cases with clinical presentation of acute coronary syndrome.ConclusionThe aim of this work was to increase recognition of EM in the light of this clinical case report of ascaris lumbricoides associated myocarditis simulating an acute coronary syndrome without ST segment elevation.

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Foreign body associated non-ST elevation myocardial infarction: a case report.

Project description:The incidence of guiding catheter tip fracture, is quite rare during percutaneous coronary interventions (PCI). Retained broken catheter tip in coronary artery and circulation can result in serious complications such as thrombosis, embolism, acute occlusion and myocardial infarction, arrhythmias and sepsis. It is mandatory to remove the fractured catheter as soon as possible to avoid these complications. Transcatheter removal is the treatment of choice. If percutaneous removal is failed, surgical intervention is advised.

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