Coronary Vasospasm, an Unexpected Side Effect of Adenosine: A Case Report and Review of the Literature

Figures

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  Figure 1. ECG in rest: sinus rhythm 60 bpm, rather short PR < 150 ms, QRS 100 ms, normal axis, RSR' in V1, QTc 480 ms.

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  Figure 2. Polymorphic PVC couplets during 1-day ECG monitoring.

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  Figure 3. Echocardiography showing a mild dilated, nonhypertrophic ventricle.

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  Figure 4. Diffuse ischemic ECG changes after 6 mg adenosine IV.

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  Figure 5. Coronary angiography showed normal coronary arteries, no epicardial spasm after 12 mg adenosine IV.

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  Figure 6. Significant QT prolongation after 12 mg papaverine IC with early afterdepolarization and resultant polymorphic VT with degeneration into ventricular fibrillation.

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  Figure 7. (a) Mild coronary artery vasoconstriction in the distal left anterior descending after 200 μg acetylcholine. (b) Reference coronary artery diameter after isosorbide dinitrate IC.

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  Figure 8. ECG after acetylcholine administration. Notice the diffuse ST depression with different T morphology compared with Figure 3. Caveat 25 mm/s, 25 mm/mV.