Exercise-induced coronary spasm with S-T segment depression and normal coronary arteriography

William E. Boden*, Edward W. Bough, Kenneth S. Korr, Ian Benham, Mihai Gheorghiade, Anthony Caputi, Richard S. Shulman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

The unique association of both exercise-induced coronary arterial spasm and S-T segment depression with normal findings on selective coronary arterlography is described. The patient had a prior history of typical effort angina that had recently progressed to angina at rest. Despite the change In anginal pattern, the electrocardiogram disclosed S-T segment depression that was consistent with subendocardial Ischemia, during both exercise testing and spontaneous chest pain. Exercise thallium-201 sclntigraphy demonstrated the presence of large perfusion defects of the anterior and septal walls of the left ventricle. Coronary arteriographie findings, in the absence of symptoms, were entirely normal. Severe localized, reversible coronary spasm of the proximal left anterior descending coronary artery was subsequently demonstrated during spontaneous angina, Isometric arm exercise and after the administration of ergonovine maleate. After treatment with isosorblde dlnitrate and nifediplne, the patient had no further chest pain or electrocardiographic changes, and a repeated thallium-201 stress test revealed nomal findings and greatly Improved exercise tolerance.

Original languageEnglish (US)
Pages (from-to)193-197
Number of pages5
JournalThe American journal of cardiology
Volume48
Issue number1
DOIs
StatePublished - Jul 1981

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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