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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