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Table 1 Timeline of the three episodes

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
  1. ECG electrocardiogram, cTnT cardiac troponin T, CK-MB creatine kinase-MB, CAG coronary angiography, LVEF left ventricular ejection fraction, DAPT dual antiplatelet therapy