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Spontaneous Reperfusion in Patients with Transient ST-Elevation Myocardial Infarction-Prevalence, Importance and Approaches to Management. Cardiovasc Drugs Ther 2023; 37:169-180. [PMID: 34245445 DOI: 10.1007/s10557-021-07226-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 01/19/2023]
Abstract
Patients with transient ST-elevation myocardial infarction (STEMI) or spontaneous resolution (SpR) of the ST-segment elevation on electrocardiogram could potentially represent a unique group of patients posing a therapeutic management dilemma. In this review, we discuss the potential mechanisms underlying SpR, its relation to clinical outcomes and the proposed management options for patients with transient STEMI with a focus on immediate versus early percutaneous coronary intervention. We performed a structured literature search of PubMed and Cochrane Library databases from inception to December 2020. Studies focused on SpR in patients with acute coronary syndrome were selected. Available data suggest that deferral of angiography and revascularization within 24-48 h in these patients is reasonable and associated with similar or perhaps better outcomes than immediate angiography. Further randomized trials are needed to elucidate the best pharmacological and invasive strategies for this cohort.
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Ahmed JJ, Walborn DL, Anghel TM, Chohan MR. Acute STEMI Due to Severe Triple-Vessel Spasm After IV Adenosine Injection During Cryo-Balloon Isolation. JACC Case Rep 2022; 4:617-620. [PMID: 35615221 PMCID: PMC9125512 DOI: 10.1016/j.jaccas.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/22/2022] [Accepted: 03/07/2022] [Indexed: 11/21/2022]
Abstract
Adenosine IV is commonly used after pulmonary vein isolation to check for dormant electrical conduction. Herein, we present the case of a 60-year-old patient who exhibited marked hypotension, conduction abnormalities, and ST-segment elevation after routine adenosine injection. Coronary angiography revealed diffuse coronary spasm that was successfully treated with intracoronary nitroglycerin. (Level of Difficulty: Intermediate.)
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Kadiyala M, Patibandla S, Michos ED. Paradoxical coronary vasospasm and transient apical ballooning in a post-menopausal woman: An imaging case report of an unusual INOCA presentation. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100101. [PMID: 38560060 PMCID: PMC10978165 DOI: 10.1016/j.ahjo.2022.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/27/2022] [Accepted: 01/30/2022] [Indexed: 04/04/2024]
Abstract
Ischemia with non-obstructive coronary artery disease (INOCA), a common cause of angina, can occur due to coronary vasospasm, microvascular dysfunction, endothelial dysfunction, atherosclerosis or a combination of these mechanisms. We describe a case of adenosine-associated paradoxical coronary vasospasm and Takotsubo-like apical ballooning in a postmenopausal woman with underlying mild coronary atherosclerosis and microvascular dysfunction.
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Affiliation(s)
- Madhavi Kadiyala
- Department of Medicine, Heart and Vascular Institute, West Virginia Univeristy, Morgantown, WV, United States of America
- Department of Cardiology, St. Francis Hospital and Heart Center, Roslyn, NY, United States of America
| | - Saikrishna Patibandla
- Department of Medicine, Heart and Vascular Institute, West Virginia Univeristy, Morgantown, WV, United States of America
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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de Mulder M, van Gameren M, van Asperen EA, Meuwissen M. A case report: adenosine triggered myocardial infarction during myocardial perfusion stress test imaging in a diabetic patient. Eur Heart J Case Rep 2021; 5:ytab133. [PMID: 33959698 PMCID: PMC8086418 DOI: 10.1093/ehjcr/ytab133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/15/2020] [Accepted: 03/12/2021] [Indexed: 12/05/2022]
Abstract
Background Myocardial perfusion imaging (MPI) using single-photon emission computed tomography (SPECT) can in general be used safely in daily clinical practice. However, under the right circumstances, it can lead to serious complications. Case summary A 68-year-old female patient with diabetes and a history of inferior ST-elevation myocardial infarction 8 years earlier, visited our outpatient clinic with atypical chest discomfort. In order to assess whether this is due to myocardial ischaemia, MPI-SPECT was ordered. As it was suspected she would not achieve sufficient exercise levels, pharmacologic stress using adenosine was arranged. During the scan, she developed acute myocardial infarction. Subsequent urgent coronary angiography demonstrated a subtotal stenosis in the proximal left anterior descending coronary artery which was successfully stented. She was still free from angina 4 months later. Discussion The combination of a reduced systemic and coronary perfusion pressure in the presence of an exhausted coronary autoregulation, may be a starting point for local geometrical changes that initiate the classic cascade of thrombus formation and acute occlusion of coronary arteries during MPI-SPECT. This illustrates the need for continuous patient and electrocardiogram monitoring.
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Affiliation(s)
- Maarten de Mulder
- Department of Cardiology, Amphia Hospital, Breda, Amphia Ziekenhuis, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Menno van Gameren
- Department of Cardiology, Amphia Hospital, Breda, Amphia Ziekenhuis, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Eric A van Asperen
- Department of Nuclear Medicine, Amphia Hospital, Breda, Amphia Ziekenhuis, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Martijn Meuwissen
- Department of Cardiology, Amphia Hospital, Breda, Amphia Ziekenhuis, Molengracht 21, 4818 CK, Breda, The Netherlands
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Li KFC, Ho HH, Yew MS. A case report of dipyridamole stress-induced ST depression progressing to ST-elevation myocardial infarction despite intravenous aminophylline: steal, spasm, or something else? Eur Heart J Case Rep 2019; 3:5480415. [PMID: 31449606 PMCID: PMC6601234 DOI: 10.1093/ehjcr/ytz054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 04/05/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Dipyridamole stress is commonly used for myocardial perfusion imaging and is generally safe. Myocardial ischaemia can occasionally occur and is classically thought to be due to coronary steal as a result of redistribution of flow away from collateral dependent myocardium. Although ischaemia more commonly presents as electrocardiographic (ECG) ST depression and angina, ST-elevation myocardial infarction may occur as a very rare complication. CASE SUMMARY We report a case of a patient who developed chest pain and ST depression during dipyridamole infusion. The pain persisted despite intravenous aminophylline with new inferior ST elevation soon after. Coronary angiography showed subtotal right coronary artery occlusion with no collateral supply. The symptoms and ECG changes resolved after percutaneous coronary intervention. DISCUSSION Coronary steal may not fully account for our patient's presentation given the failure of aminophylline and absent angiographic collaterals. Vasospasm may be triggered by dipyridamole and can directly cause ischaemia or provoke rupture of an unstable plaque. Augmentation of cardiac energetics during vasodilator stress may also play a role.
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Affiliation(s)
- Ki Fung Cliff Li
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, Singapore
| | - Hee Hwa Ho
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, Singapore
| | - Min Sen Yew
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, Singapore, Corresponding author. Tel: +6562566011, Fax: +6563526682,
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Blondheim DS, Kleiner-Shochat M, Asif A, Kazatsker M, Frimerman A, Abu-Fanne R, Neiman E, Barel M, Levy Y, Amsalem N, Shotan A, Meisel SR. Characteristics, Management, and Outcome of Transient ST-elevation Versus Persistent ST-elevation and Non-ST-elevation Myocardial Infarction. Am J Cardiol 2018; 121:1449-1455. [PMID: 29699746 DOI: 10.1016/j.amjcard.2018.02.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/22/2018] [Accepted: 02/27/2018] [Indexed: 12/13/2022]
Abstract
Patients with acute myocardial infarctions (AMIs) present as persistent ST-elevation myocardial infarction (STEMI) or as non-ST-segment elevation myocardial infarction (NSTEMI). In some patients with STEMI, ST elevations are transient and resolve before coronary intervention (transient ST-elevation myocardial infarction [TSTEMI]). We analyzed our registry comprising all consecutive patients with AMI admitted during 2009 to 2014, and compared the characteristics, management, and outcome of patients with TSTEMI with those of patients with STEMI and NSTEMI. Of 1,847 patients with AMI included in the registry, 1,073 patients sustained a STEMI (58%), 649 had a NSTEMI (35%), and 126 presented with TSTEMI (6.9%). Patients with TSTEMI were younger than patients with NSTEMI and STEMI (56.5 vs 62.8, p <0.001, and 59.5 years, p <0.02, respectively), smoked more (77.8 vs 54.0, p <0.001, and 62.1%, p <0.0005), and fewer were hypertensive (52.4 vs 74.2% and 58.8%, both p <0.001) and diabetic (26.2% vs 47.7%, p <0.0001, and 36.9%, p <0.02). The extent of coronary artery disease in patients with TSTEMI was similar to that of patients with STEMI except for less involvement of the left anterior descending artery (p <0.001), but less extensive than in NSTEMI patients. TSTEMI involved less myocardial damage by troponin-T level (p <0.005) with better cardiac function (LVEF 61% vs 55% and 49%, both p <0.0001). Mortality was lower among TSTEMI both in-hospital (0 vs 2.3% [p = NS] and 4.2% [p <0.01]) and long-term (4.8% vs 14.7% and 14.2%, both p <0.003) at a median of 36 months. In conclusion, TSTEMI is an acute coronary syndrome distinct from NSTEMI and STEMI, characterized by fewer risk factors, a similar extent of coronary artery disease to STEMI, but is associated with less myocardial damage and portends a better outcome.
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Nam JG, Choi SH, Kang BS, Bang MS, Kwon WJ. Development of Coronary Vasospasm during Adenosine-Stress Myocardial Perfusion CT Imaging. Korean J Radiol 2015; 16:673-7. [PMID: 25995700 PMCID: PMC4436000 DOI: 10.3348/kjr.2015.16.3.673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/19/2015] [Indexed: 11/15/2022] Open
Abstract
Adenosine is a short-acting coronary vasodilator, and it is widely used during pharmacological stress myocardial perfusion imaging. It has a well-established safety profile, and most of its side effects are known to be mild and transient. Until now, coronary vasospasm has been rarely reported as a side effect of adenosine during or after adenosine stress test. This study reports a case of coronary vasospasm which was documented on stress myocardial perfusion CT imaging during adenosine stress test.
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Affiliation(s)
- Jeong Gu Nam
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, Korea
| | - Seong Hoon Choi
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, Korea
| | - Byeong Seong Kang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, Korea
| | - Min Seo Bang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, Korea
| | - Woon Jeong Kwon
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, Korea
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Sun H, Tian Y, Zheng L, Pan Q, Xie B. Electrocardiographic profile of adenosine pharmacological stress testing. Exp Ther Med 2015; 9:1178-1184. [PMID: 25780406 PMCID: PMC4353738 DOI: 10.3892/etm.2015.2279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 01/26/2015] [Indexed: 11/18/2022] Open
Abstract
Adenosine stress testing in conjunction with radionuclide myocardial perfusion imaging has become a common approach for the detection of coronary artery diseases in patients who are unable to perform adequate levels of exercise. However, specific electrocardiographic alterations during the test have been rarely described. Using a Chinese population, the aim of the present study was to provide a detailed electrocardiographic profile of adenosine stress testing. The study population included 1,168 consecutive outpatients who had undergone adenosine-induced stress myocardial perfusion imaging. Electrocardiographic data during and immediately following the adenosine infusion were collected, and the corresponding myocardial perfusion images were assessed. During adenosine infusion, 174 transient and 47 persistent arrhythmic events occurred in 110 patients (9.42%). Furthermore, frequent premature atrial contractions occurred in 65 individuals and frequent premature ventricular contractions were observed in 73 individuals. Atrioventricular block (AVB) occurred in 75 patients [first degree (I°) AVB, 16; second degree (II°) AVB, 58; third degree AVB, 1), while sinoatrial block occurred in eight patients. ST depression emerged in 69 patients. Patients with a baseline I° AVB had an increased risk of a II° AVB, and patients exhibiting baseline ST depression were more likely to have a further depressed ST segment during the stress test (odds ratio, 28.68 and 5.01, respectively; both P<0.001). Following adenosine infusion, 10 patients (0.86%) exhibited newly occurred arrhythmic events. However, no patient presented with acute myocardial infarction or sudden mortality. In conclusion, the results demonstrated that adenosine infusion was a safe method, despite the relatively high incidence of arrhythmic events. The majority of arrhythmias that occurred during infusion were transient, were reversible with the termination of infusion and did not indicate abnormal perfusion results.
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Affiliation(s)
- Hao Sun
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Yueqin Tian
- Department of Nuclear Medicine, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Lihui Zheng
- Department of Electrophysiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Qingrong Pan
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Boqia Xie
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
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Matsumoto N, Nagao K, Hirayama A, Kasama S. Adenosine-induced coronary vasospasm following drug-eluting stent implantation. BMJ Case Rep 2014; 2014:bcr-2013-202996. [PMID: 24518394 DOI: 10.1136/bcr-2013-202996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of coronary vasospasm during adenosine stress in a patient with a prior drug-eluting stent implantation. The patient had a stent implantation in the left anterior descending coronary artery 3 years ago. Recently, he developed a chest pain and underwent adenosine stress myocardial perfusion single photon emission CT (SPECT). During the adenosine stress, he felt severe chest pain and ST elevation on electrocardiogram. An invasive coronary angiography showed no in-stent restenosis. This phenomenon deemed to be adenosine-induced coronary vasospasm after stent implantation.
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Affiliation(s)
- Naoya Matsumoto
- Department of Cardiology, Nihon University Surugadai Hospital, Tokyo, Japan
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Arora P, Bhatia V, Arora M, Kaul U. Adenosine induced coronary spasm – A rare presentation. Indian Heart J 2014; 66:87-90. [PMID: 24581102 PMCID: PMC4054841 DOI: 10.1016/j.ihj.2013.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 12/12/2013] [Indexed: 11/22/2022] Open
Abstract
Adenosine is commonly used as a pharmacological agent in myocardial perfusion imaging, as an antiarrhythmic agent, and in Cath Lab. during PCI for treating no reflow phenomenon. Coronary spasm has been reported following adenosine injection during stress imaging. We report a rare complication with ST segment elevation, following adenosine injection, given for treatment of supraventricular tachycardia.
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Peters MN, Bhattasli O, Burchett AR, Howell LA, Turnage TA, Katz MJ, Delafontaine P, Irimpen AM. Coronary angiographic significance of hyperacute ST-T changes associated with regadenoson stress. Proc AMIA Symp 2013; 26:277-9. [PMID: 23814390 DOI: 10.1080/08998280.2013.11928982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
An abnormal electrocardiographic stress test is typically characterized by ST segment depression. In rare cases, ST segment elevation is observed, which, in the absence of diagnostic Q waves, has anatomic specificity for localized myocardial ischemia. Most instances of ST elevation occurring during cardiac stress testing have been observed with exercise, with only six cases reported with pharmacologic stress. Despite different physiologic mechanisms for inducing myocardial ischemia, development of ST segment elevation during pharmacologic stress, as illustrated by the present case, may also be indicative of critical coronary stenoses, warranting urgent coronary arteriography.
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Affiliation(s)
- Matthew N Peters
- Department of Internal Medicine, Tulane University Health Sciences Center, New Orleans, LA
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Coronary vasospasm while treating supraventricular tachycardia: is adenosine really to blame? Case Rep Cardiol 2013; 2013:897813. [PMID: 24826297 PMCID: PMC4008346 DOI: 10.1155/2013/897813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/19/2013] [Indexed: 11/20/2022] Open
Abstract
Coronary artery spasm has been reported during adenosine stress testing. Herein, we describe a transient ST-segment elevation following adenosine therapy for supraventricular tachycardia. A 38-year-old male presented to the emergency department with palpitations. Electrocardiogram showed supraventricular tachycardia with short RP interval. Vagal maneuvers were unsuccessful. Adenosine was then administered in two successive injections of 6 and 12 mg dosages, respectively. A subsequent 12-lead electrocardiogram revealed ST-segment elevation in inferior leads with reciprocal changes. Coronary angiography disclosed nonobstructive coronary disease. A postprocedure electrocardiogram exhibited normal sinus rhythm with nonspecific T wave abnormalities. Cardiac biomarkers were elevated with a peak troponin I of 0.32. Echocardiogram depicted bicuspid aortic valve and normal systolic function. Electrophysiological study revealed a concealed left accessory pathway and successful radiofrequency ablation was performed. Given the dynamic changes in the electrocardiogram, we hypothesize that this event was most likely a coronary vasospasm. The mechanism of coronary spasm following adenosine injection remains uncertain. Potential mediators include KATP channels and adenosine-2 receptors.
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Ismail M, Asaad N, Al-Suwaidi J. Adenosine-induced coronary artery spasm: a case report. Med Princ Pract 2012; 21:82-5. [PMID: 22024961 DOI: 10.1159/000331809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Accepted: 04/14/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe an uncommon complication of intravenous adenosine administration. CLINICAL PRESENTATION AND INTERVENTION A 41-year-old female patient presented with palpitations due to supraventricular tachycardia. The patient was treated with intravenous adenosine with resolution of the tachycardia. Subsequently, the patient developed chest pain and ST segment elevation in the inferior leads that resolved with sublingual nitroglycerin. CONCLUSION This report showed a case of coronary spasm secondary to the administration of adenosine. We therefore recommend that discretion be exercised when giving adenosine, especially to patients with an underlying tendency for vasospastic reactions.
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Affiliation(s)
- Montaser Ismail
- Department of Cardiology and Cardiac Surgery, Hamad Medical Corporation, Doha, Qatar
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Han PP, Tian YQ, Wei HX, Wang Q, He ZX. Coronary spasm after completion of adenosine pharmacologic stress test. Ann Nucl Med 2011; 25:580-5. [PMID: 21573869 DOI: 10.1007/s12149-011-0493-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 04/06/2011] [Indexed: 11/30/2022]
Abstract
Adenosine is a frequently used pharmacologic stress agent in myocardial perfusion imaging. Its safety profile is well established, and most of its side effects are mild and transient. Coronary vasospasm occurs occasionally during or after adenosine stress test in rare cases, which may lead to seriously adverse outcomes. This study reported 3 such cases after completion of adenosine pharmacologic stress test.
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Affiliation(s)
- Ping-Ping Han
- Department of Nuclear Medicine, Cardiovascular Institute, Chinese Academy of Medical Sciences, 167 Bei Li Shi Lu, Beijing, 100037, China.
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Coronary arterial spasm during adenosine myocardial perfusion imaging. J Cardiol 2008; 53:288-92. [PMID: 19304135 DOI: 10.1016/j.jjcc.2008.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 07/05/2008] [Accepted: 07/15/2008] [Indexed: 11/19/2022]
Abstract
Adenosine is widely used as a pharmacologic agent for stress myocardial perfusion imaging. Vasospasm as a side effect of adenosine has been reported a few times in other countries, but it has not been reported in Japan. A 65-year-old woman was admitted to our hospital because of chest pain at rest and during exercise. She underwent myocardial scintigraphy, to rule out myocardial ischemia. After adenosine infusion, she felt chest pain and the electrocardiogram (ECG) showed ST elevation in inferior leads. Adenosine infusion was stopped immediately. Her chest pain resolved, and the ECG reverted to baseline. Perfusion image presented reverse redistribution in inferior segments, and coronary angiography revealed insignificant lesions. Transient ST elevation during adenosine infusion is thought to be due to coronary vasospasm, judging from scintigraphic and angiographic findings.
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Intermittent ST-segment depressions during adenosine stress test. Clin Nucl Med 2007; 32:927-9. [PMID: 18030042 DOI: 10.1097/rlu.0b013e3181596664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ST-segment depression during adenosine stress testing is usually a 1-time event during or after the test and is often related to ischemia due to severe 3-vessel disease. In this case report we describe a patient with severe 3-vessel disease who had intermittent ST-segment depression on the electrocardiogram during a myocardial perfusion stress test with adenosine. These intermittent ST depressions could be explained by possible adenosine-induced coronary spasm.
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Faganello G, Belham M. Coronary vasospasm during an adenosine stress test. Int J Cardiol 2006; 113:E84-6. [PMID: 16843554 DOI: 10.1016/j.ijcard.2006.04.074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Accepted: 04/29/2006] [Indexed: 11/26/2022]
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