ST-T wave changes in a patient complicated with vasospastic angina and Brugada syndrome: differential responses to acetylcholine in right and left coronary artery

• Published in: Heart and vessels Vol. 23; no. 3; pp. 201 - 205
• Main Authors: Nishizaki, Mitsuhiro, Fujii, Hiroyuki, Ashikaga, Takashi, Yamawake, Noriyoshi, Sakurada, Harumizu, Hiraoka, Masayasu
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.05.2008; Springer Nature B.V
• Subjects: Acetylcholine; Angina pectoris; Angina Pectoris, Variant - etiology; Angina Pectoris, Variant - physiopathology; Biomedical Engineering and Bioengineering; Brugada Syndrome - complications; Brugada Syndrome - physiopathology; Brugada Syndrome - therapy; Cardiac Surgery; Cardiology; Case Report; Case studies; Coronary Angiography; Coronary Vasospasm - complications; Coronary Vasospasm - physiopathology; Coronary vessels; Coronary Vessels - drug effects; Coronary Vessels - physiopathology; Defibrillators, Implantable; Electrocardiography; Electrophysiologic Techniques, Cardiac; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Neurotransmitters; Syncope - etiology; Syncope - physiopathology; Vascular Surgery; Vasoconstriction - drug effects; Ventricular Fibrillation - etiology; Ventricular Fibrillation - physiopathology; Ventricular Fibrillation - therapy; Vasospastic angina; Coronary spasm; Acetylcholine; Brugada syndrome; ST-segment elevation; Ventricular fibrillation
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-007-1036-3

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.