Young-Onset Type 2 Diabetes and Its Association with Variant Angina in an Adolescent

Abstract

BACKGROUND Variable angina pectoris is a special type of unstable angina pectoris, the pathological basis of which is coronary artery spasm, resulting in rapid myocardial ischemia and hypoxia. This spasm may be related to autonomic nervous dysfunction, coronary endothelial cell dysfunction, inflammation, genetics, and other factors. Here, we focus on the association between autonomic dysfunction and variable angina in young-onset type 2 diabetes and differentiation of its variant, angina pectoris, from early acute myocardial infarction. CASE REPORT We present the case of an adolescent patient with type 2 diabetes who was admitted to the hospital due to chest pain. After completing electrocardiography and finding transient ST-segment elevation, the patient underwent emergency coronary angiography without significant vascular stenosis and was diagnosed with variant angina pectoris. The patient was then treated with hypoglycemic drugs and vasospasm-improving drugs. CONCLUSIONS For families with a history of diabetes, it is critical to get the children of the sick parent or relative to the hospital in time for proper diagnostic testing. Upon confirmation of the disease, immediate medical intervention is advised to mitigate the risk of serious cardiovascular issues such as autonomic dysfunction related to vascular spastic angina pectoris. Second, it is difficult to distinguish between variable angina pectoris and early acute myocardial infarction, so coronary angiography should be performed as early as possible to avoid delayed treatment.

Figure 1. Electrocardiogram (ECG) at the time of admission

Sinus tachycardia with inverted T waves in leads II, III, and aVF.

Figure 2. ECG during chest pain attack

The ST segments of leads I, II, aVL, and V2–V6 were elevated.

Figure 3. Electrocardiogram at the time of re-examination

Sinus tachycardia with inverted T waves in leads II, III, and aVF.

Figure 4. Emergency coronary angiography

No stenosis was found in the left main trunk, LAD, LCX, and RCA. Myocardial bridge in the middle of the left anterior descending branch was found, and TIMI blood flow in the left and right coronary arteries was grade 3.

Figure 5. Time-signal curve of myocardial perfusion

The horizontal axis represents time, while the vertical axis represents signal intensity. Different colors represent different regions: bright green indicates the anterior wall, pink represents the anterolateral wall, light blue indicates the inferior lateral wall, dark blue represents the inferior wall, dark green indicates the inferoseptal wall, and yellow represents the anteroseptal wall.