Abstract
A 49-year-old man with chest pain and syncope presented saddleback or occasionally coved type ST elevation in V1–V3. Coronary spasm in the left anterior descending artery was induced by acetylcholine injection and ST elevation changed from saddleback to coved type in V2–V3 together with ST depression in V4–V5, whereas acetylcholine injection into the right coronary artery did not provoke spasm, but induced augmented and coved type ST elevation in V2 without ST-T changes in V4–V5. These electrocardiographic changes in response to acetylcholine administration into each coronary artery are compatible with pathogenesis of vasospastic angina and Brugada syndrome, respectively.
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References
Myerburg RJ, Kessler KM, Mallon SM, Cox MM, DeMarchena E, Interian A, Castellanos A (1992) Life-threatening ventricular arrhythmias in patients with silent myocardial ischemia due to coronary artery spasm. N Engl J Med 326:1451–1455
Nishizaki M, Arita M, Sakurada H, Suzuki M, Ashikaga T, Yamawake N, Numano F, Hiraoka M (2001) Polymorphic ventricular tachycardia in patients with vasospastic angina. Clinical and electrocardiographic characteristics and long-term outcome. Jpn Circ J 65:519–525
Nishizaki M, Arita M, Sakurada H, Suzuki M, Ashikaga T, Yamawake N, Numano F, Hiraoka M (1996) Induction of polymorphic ventricular tachycardia by programmed ventricular stimulation in vasospastic angina pectoris. Am J Cardiol 77:355–360
Suzuki M, Nishizaki M, Arita M, Ashikaga T, Yamawake N, Kakuta T, Numano F, Hiraoka M (1998) Increased QT dispersion in patients with vasospastic angina. Circulation 98:435–440
Brugada J, Brugada R, Brugada P (1998) Right bundle-branch block and ST-segment elevation in leads V1 through V3. A marker for sudden death in patients without demonstrable structural heart disease. Circulation 97:457–460
Antzelevitch C (2001) The Brugada syndrome: Ionic basis and arrhythmia mechanism. J Cardiovasc Electrophysiol 12:268–272
Yan GX, Antzelevitch C (1999) Cellular basis for the Brugada syndrome and other mechanisms of arrhythmogenesis associated with ST-segment elevation. Circulation 100:1660–1666
Yan GX, Lankipalli RS, Burke JF, Musco S, Kowey PR (2003) Ventricular repolarization components on the electrocardiogram: Cellular basis and clinical significance. J Am Coll Cardiol 42:401–409
Yan GX, Joshi A, Guo D, Hlaing T, Martin J, Xu X, Kowey PR (2004) Phase 2 reentry as a trigger to initiate ventricular fibrillation during early acute myocardial ischemia. Circulation 110:1036–1041
Chinushi M, Kuroe Y, Ito E, Tagawa M, Aizawa Y (2001) Vasospastic angina accompanied by Brugada-type electrocardiographic abnormalities. J Cardiovasc Electrophysiol 12:108–111
Noda T, Shimizu W, Taguchi A, Satomi K, Suyama K, Kurita T, Aihara N, Kamakura S (2002) ST-segment elevation and ventricular fibrillation without coronary spasm by intracoronary injection of acetylcholine and/or ergonovine maleate in patients with Brugada syndrome. J Am Coll Cardiol 40:1841–1847
Wada M, Hara H, Nakamura M. (2006) A change in the pattern of vasospasm after stenting in a patient with vasospastic angina. Heart Vessels 21:388–391
Suzuki M, Nishizaki M, Arita M, Kakuta T, Numano F (1996) Impaired glucose tolerance with late hypersecretion of insulin during oral glucose tolerance test in patients with vasospastic angina. J Am Coll Cardiol 27:1458–1468
Nishizaki M, Sakurada H, Ashikaga T, Yamawake N, Fujii H, Arita M, Isobe M, Hiraoka M (2003) Effects of glucose-induced insulin secretion on ST segment elevation in the Brugada syndrome. J Cardiovasc Electrophysiol 14:243–249
Lukas A, Antzelevitch C (1993) Differences in the electrophysiological response of canine ventricular epicardium and endocardium to ischemia, Role of the transient outward current. Circulation 88:2903–2915
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Nishizaki, M., Fujii, H., Ashikaga, T. et al. ST-T wave changes in a patient complicated with vasospastic angina and Brugada syndrome: differential responses to acetylcholine in right and left coronary artery. Heart Vessels 23, 201–205 (2008). https://doi.org/10.1007/s00380-007-1036-3
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DOI: https://doi.org/10.1007/s00380-007-1036-3