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. 2013:2013:897813.
doi: 10.1155/2013/897813. Epub 2013 Apr 10.

Coronary vasospasm while treating supraventricular tachycardia: is adenosine really to blame?

Henry C Quevedo  1 , Jerson Munoz-Mendoza  2 , Veronica Pinto Miranda  3 , Rafael F Sequeira  4
Affiliations

Coronary vasospasm while treating supraventricular tachycardia: is adenosine really to blame?

Henry C Quevedo et al. Case Rep Cardiol. 2013.

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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Figures

Figure 1
Figure 1
12-lead ECG on admission exhibiting supraventricular tachycardia with short RP interval.
Figure 2
Figure 2
Continuous ECG recording depicts the response to the second dose of adenosine (12 mg). After the initial delayed conduction in the atrioventricular node and sinus node, sinus pause arose. Sinus rhythm then resumed and ST-segment elevation in leads II, III, and aVF with ST-segment depression in leads I, aVL, and V1-V3 are seen.
Figure 3
Figure 3
12-lead ECG is depicting an ST-segment elevation in inferior leads and reciprocal changes in lead I, and morphology of right bundle branch block (rsR') in lead V1 with ST-segment depressions in V1-V3 is observed after the adenosine injection.
Figure 4
Figure 4
Conventional angiographic projections are shown to evaluate the left anterior descending artery, circumflex artery (cranial and oblique projections, (a) and (b), resp.), and right coronary artery (cranial and oblique, (c) and (d), resp.). No significant coronary disease was seen.
Figure 5
Figure 5
Follow-up 12-lead ECG exhibited normal sinus rhythm.
See this image and copyright information in PMC

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