Cyclic ST-segment elevation after primary percutaneous coronary intervention
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Neth Heart J https://doi.org/10.1007/s12471-020-01498-8
Cyclic ST-segment elevation after primary percutaneous coronary intervention W. P. J. Jansen
Accepted: 29 September 2020 © The Author(s) 2020
A 44-year-old man was admitted for an inferior STelevation myocardial infarction (STEMI), for which he underwent successful primary percutaneous coronary intervention of the occluded right coronary artery (RCA). Several hours later, ST-segment monitoring revealed a strikingly regular pattern of intermittent inferior ST-elevation, confirmed by 12lead electrocardiography (Fig. 1a). Following sublingual administration of nitroglycerin, the ST-elevation completely resolved; however, it reoccurred after 1 h (Fig. 1b). Repeat angiography showed a patent RCA with Thrombolysis in Myocardial Infarction (TIMI) III flow. Intravenous nitrates and oral diltiazem were administered, after which the phenomenon did not reoccur. Cyclic ST-elevation after acute coronary syndromes has been described previously [1]. I found one similar case of intermittent ST-elevation after NSTEMI, which was reversed by intravenous nitrates [2]. Several hypotheses have been postulated, including coronary vasospasm and platelet-mediated thrombus formation [3, 4]. Angiographic results and response to spasmolytic agents suggest a vasospastic phenomenon. The explanation for the strikingly cyclic pattern, however, remains to be elucidated.
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References 1. Albertal M, Cura F, Krucoff MW, et al. Coronary cyclic flow variations following primary angioplasty is associated with poor short-term prognosis. Int J Cardiol. 2008;130:220–6. 2. Azzarone M, Fasulo A, Leuzzi C, et al. Complete sustained reversalofcyclicST-segmentelevation(coronarycyclicflow variations) by low-dose intravenous nitroglycerin during acutecoronarysyndrome. JElectrocardiol. 2014;47:219–22. 3. Koiwaya Y, Torii S, Takeshita A, et al. Postinfarction angina caused by coronary artery spasm. Circulation. 1982;65:275–80. 4. Folts JD, Stamler JS, Loscalzo J. Intraveneous nitroglycerin infusion inhibits cyclic blood flow responses caused by periodic platelet thrombus formation in stenosed canine coronary arteries. Circulation. 1991;83:2122–7.
Conflict of interest W.P.J. Jansen declares that he has no competing interests. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to th
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