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Gepubliceerd in: Netherlands Heart Journal 12/2020

Open Access 09-10-2020 | Heart Beat

Cyclic ST-segment elevation after primary percutaneous coronary intervention

Auteur: W. P. J. Jansen

Gepubliceerd in: Netherlands Heart Journal | Uitgave 12/2020

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A 44-year-old man was admitted for an inferior ST-elevation 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 12-lead 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.

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 the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.
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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

Literatuur
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Metagegevens
Titel
Cyclic ST-segment elevation after primary percutaneous coronary intervention
Auteur
W. P. J. Jansen
Publicatiedatum
09-10-2020
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 12/2020
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-020-01498-8