Adenosine-induced coronary artery spasm: a case report

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.

Should thrombolysis have a greater role in the management of pulmonary embolism?

Pulmonary embolism (PE) continues to be associated with significant mortality despite advances in the diagnostic techniques available for its detection. Anticoagulation remains standard treatment in PE although there is a consensus view that 'step-up' to thrombolytic therapy in addition to anticoagulation is indicated in those patients who are systemically shocked at presentation--a group defined as having suffered 'massive pulmonary embolism'. Considerable research has been directed at attempting to identify further groups of patients with PE who are at high risk of morbidity and mortality--notably those who are labelled as having suffered 'sub-massive pulmonary embolism' where this is defined as the presence of right-heart strain in the absence of systemic shock. In particular, the potential benefit of extending thrombolytic therapy to include those patients with sub-massive PE has been the subject of much enquiry and debate. This review examines the evidence for thrombolytic therapy and explores the potential for risk stratification in PE.

Noncardiac chest pain: epidemiology, natural history, health care seeking, and quality of life

The epidemiology of NCCP is poorly described, and the available data are conflicting. Population-based studies on the prevalence of NCCP are rare; most studies have been hospital based. According to the limited studies available, the annual prevalence of NCCP is approximately 25%. Despite this significant burden, the impact and natural history of NCCP in the community has not been adequately explored. NCCP is presumed to bea heterogeneous condition. Hospital-based studies have suggested that GERD, esophageal spasm, psychiatric disease (including panic attacks), and musculoskeletal pain explain many cases of NCCP. However, unrecognized coronary artery disease and microvascular angina (cardiac syndrome X)also explain an unknown proportion of cases in the general population.Current studies suggest that NCCP is common in the general population and significantly affects QOL, yet only a minority seeks medical attention.The epidemiology of NCCP requires further study in the general population and in those attending the Emergency Department.