From: Alternate recurrent coronary artery spasm and stress cardiomyopathy: a case report
Date | Episode | Main symptoms | Main examination | Medication | |
---|---|---|---|---|---|
2016-10-07 | First | Mild paroxysmal chest pain without obvious inducement for approximately 2 years | On arrival | ECG revealed poor R wave progression and suspicious ST-segment elevation in V1–3 leads Echocardiogram findings and cTnT and CK-MB levels were normal Coronary computed tomography angiography showed mild coronary atherosclerotic lesions | He refused to take any medicine at that time |
2017-02-15 | Second | Chest pain aggravated 1 h ago after waking up (without physical or emotional triggers) at about 7:30 a.m | On arrival | ECG revealed ST-segment elevation in V2–6 leads Emergency CAG was performed that showed no significant atherosclerotic lesions Left ventriculography revealed apical hypokinesis with a classic apical ballooning shape Echocardiogram showed severe apical hypokinesis, and LVEF was 52% CK-MB and cTnT levels were elevated | Aspirin, clopidogrel, statins, angiotensin II type 1 receptor blockers, beta-adrenergic blockers, and insulin. (DAPT stopped after 1 year) |
5 days later | ECG showed recovered ST-segment elevation in V2–6 leads, echocardiogram revealed no significant improvement | ||||
8 months later | Echocardiogram showed moderate apical hypokinesis, and LVEF was 55% | ||||
26 months later | ECG revealed no ST-segment elevation, echocardiogram showed mild apical hypokinesis, and LVEF was 68.7% | ||||
2019-10-04 | Third | Severe chest pain occurred again 8 h ago when he was resting at about 2:39 a.m | On arrival | ECG revealed ST-segment elevation in II, III, avF, and V1–4 leads. Echocardiogram showed mild left ventricular wall motion reduction, severe apical hypokinesis, and LVEF was 55% Emergency CAG revealed severe stenoses in the left anterior descending and posterior left ventricle arteries, which reversed after intracoronary injection of nitroglycerin CK-MB and cTnT levels were normal | Calcium channel blockers, statins, and insulin |
3 days later | ECG revealed recovered ST-segment elevation in II, III, avF, and V1–4 leads. Echocardiogram showed normal left ventricular wall motion and mild apical hypokinesis, and LVEF was 70.8% | He was insisted on medication and regular follow-up after discharge | |||
No chest pain | Till date | No drug dose adjusted |