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ST elevation in recovery post exercise with normal coronary arteries.
BMJ Case Rep. 2019 Jul 08; 12(7)BC

Abstract

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.

Authors+Show Affiliations

Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.Manchester Heart Center, Manchester Royal Infirmary, Manchester, UK.Manchester Heart Center, Manchester Royal Infirmary, Manchester, UK.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

31289167

Citation

Aghamohammadzadeh, Reza, et al. "ST Elevation in Recovery Post Exercise With Normal Coronary Arteries." BMJ Case Reports, vol. 12, no. 7, 2019.
Aghamohammadzadeh R, El-Omar SM, Rowlands D, et al. ST elevation in recovery post exercise with normal coronary arteries. BMJ Case Rep. 2019;12(7).
Aghamohammadzadeh, R., El-Omar, S. M., Rowlands, D., & El-Omar, M. (2019). ST elevation in recovery post exercise with normal coronary arteries. BMJ Case Reports, 12(7). https://doi.org/10.1136/bcr-2019-229766
Aghamohammadzadeh R, et al. ST Elevation in Recovery Post Exercise With Normal Coronary Arteries. BMJ Case Rep. 2019 Jul 8;12(7) PubMed PMID: 31289167.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - ST elevation in recovery post exercise with normal coronary arteries. AU - Aghamohammadzadeh,Reza, AU - El-Omar,Suhaib Magdi, AU - Rowlands,Derek, AU - El-Omar,Magdi, Y1 - 2019/07/08/ PY - 2021/07/08/pmc-release PY - 2019/7/11/entrez PY - 2019/7/11/pubmed PY - 2020/1/14/medline KW - interventional cardiology KW - ischaemic heart disease JF - BMJ case reports JO - BMJ Case Rep VL - 12 IS - 7 N2 - 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. SN - 1757-790X UR - https://www.unboundmedicine.com/medline/citation/31289167/ST_elevation_in_recovery_post_exercise_with_normal_coronary_arteries. L2 - https://casereports.bmj.com/lookup/pmidlookup?view=long&pmid=31289167 DB - PRIME DP - Unbound Medicine ER -