Key result
Aminophylline reversal after negative dipyridamole stress echo paradoxically triggers acute coronary vasospasm and ST elevation.
Case Report (n=1)
No
This case highlights the potential for aminophylline to unmask vasospastic angina when used for vasodilator reversal, even after a negative dipyridamole stress echocardiography.
Aminophylline reversal may provoke acute ischemia after negative dipyridamole stress echo; single case leaves open incidence and mechanisms.
We report the case of a 58-year-old patient with chronic ischemic syndrome who underwent dipyridamole stress echocardiography for the evaluation of chest pain. The stress test was negative with normal coronary flow velocity reserve, preserved chronotropic competence, and no inducible wall motion abnormalities. However, upon administration of aminophylline at the end of the test, the patient developed acute chest pain, ST-segment elevation, and severe apical wall motion abnormalities. These findings resolved with intravenous nitrates. Subsequent coronary angiography revealed a significant vasospastic stenosis in the left anterior descending artery superimposed on a mild organic stenosis of around 50% after intracoronary nitrates. The coronary stenosis was successfully treated with a drug-eluting stent. This case highlights the potential for vasospastic angina to be unmasked following vasodilator reversal, even after a negative stress echocardiography.
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Cortigiani et al. (2025) conducted a case report in Vasospastic angina (n=1). Aminophylline was evaluated on Development of coronary vasospasm. Aminophylline administration following a negative dipyridamole stress echocardiography paradoxically induced acute coronary vasospasm, ST-segment elevation, and severe apical wall motion abnormalities.
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