ST elevation in recovery post exercise with normal coronary arteries

Autor: Suhaib Magdi El-Omar, Reza Aghamohammadzadeh, Magdi El-Omar, Derek J. Rowlands
Rok vydání: 2019
Předmět:
Male
Spasm
medicine.medical_specialty
media_common.quotation_subject
Hemodynamics
Post-Exercise Hypotension
030204 cardiovascular system & hematology
Coronary Angiography
Diagnosis
Differential
Diltiazem
Electrocardiography
03 medical and health sciences
0302 clinical medicine
Bruce protocol
Internal medicine
medicine
Humans
ST segment
cardiovascular diseases
media_common
Interventional cardiology
business.industry
ST elevation
Cardiovascular Agents
General Medicine
Middle Aged
medicine.disease
Coronary Vessels
Treatment Outcome
Blood pressure
Echocardiography
Coronary vasospasm
Exercise Test
Cardiology
ST Elevation Myocardial Infarction
business
030217 neurology & neurosurgery
Findings That Shed New Light on the Possible Pathogenesis of a Disease or an Adverse Effect
Vigilance (psychology)
Zdroj: BMJ Case Rep
ISSN: 1757-790X
DOI: 10.1136/bcr-2019-229766
Popis: 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.
Databáze: OpenAIRE
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