A case report of Brugada-like ST-segment elevation probably due to coronary vasospasm

Abstract

Rationale: Vasospastic angina is caused by sudden occlusive vasoconstriction of a segment of an epicardial artery, with transient ST-segment elevation on electrocardiography. Brugada Syndrome is an inherited arrhythmogenic cardiac disorder with a diagnostic electrocardiography characterized by coved-type ST-segment elevation in right precordial leads (V1-V3). Those two diseases usually have no correlation. In this report, we discuss an interesting case of a patient who was diagnosed as vasospastic angina according to his coronary angiography, but his electrocardiography showed a Brugada-like ST-segment elevation.

Patient concerns: Our patient had a 9-month history of temporary but progressive substernal burning sensation with acid bilges of shoulders and arms, as well as profuse sweating at night.

Diagnoses: Although he had no abnormal laboratory test result, no dysfunctional recorded echocardiogram or documented arrhythmia after being admitted to the hospital, his electrocardiography showed a Brugada-like ST-segment elevation. The coronary angiography result confirmed a diagnosis of vasospastic angina.

Interventions: The patient was prescribed diltiazem, aspirin, isosorbide mononitrate and rosuvastatin and was strongly advised to quit cigarettes and alcohol.

Outcomes: Follow-up at half a year turned out well.

Lessons: This case links Brugada syndrome to coronary vasospasm. They may share similar mechanisms. Provocation test and gene test needs to be ran to distinguish both. Long-term follow-up is essential for it may bring a warning sign for life threatening ventricular arrhythmias.

Figure 1

(A) Coved ST-segment elevation of approximately 0.3 to 0.8 mV in V1–V3 precordial leads and 0.5 to 0.7 mV in II, III, aVF limb leads, and “mirror change” in I, aVL. (B) Right bundle branch block (RBBB) in V3R–V5R, a ventricular premature contraction with long pause.

Figure 2

(A) Roughly normal electrocardiogram. (B) Roughly normal electrocardiogram.

Figure 3

Coronary angiography was done after intravenous nitroglycerin and normalization of electrocardiogram. (A) Left coronary artery (straight caudal). (B) Right coronary artery (straight cranial). (C) Left coronary artery (right cranial), the red arrow shows a moderate stenosis of the middle of anterior descending branch. (D) Right coronary artery (left anterior oblique), the red arrow indicating conus branch.