Recurrent ST Elevation Myocardial Infarction from Norepinephrine-induced Coronary Vasospasm

Figures

• 

  Figure 1. Electrocardiogram (ECG) shows ST segment elevation in the inferior leads. ECG shows atrial fibrillation, ST segment elevation in the inferior leads, and reciprocal ST segment depression.

• 

  Figure 2. Initial electrocardiogram (ECG) on the first admission. Initial ECG on the first admission shows normal sinus rhythm without ST segment changes.

• 

  Figure 3. Coronary angiogram of the patient. Right coronary injection shows significant narrowing (white arrow) of the right coronary artery in the distal part.

• 

  Figure 4. Coronary angiogram of the patient after administration of intracoronary nitroglycerin. Right coronary injection shows complete resolution of distal right coronary artery vasospasm (white arrow) after administration of intracoronary nitroglycerin. The sinoatrial nodal branch and the atrioventricular nodal artery can be seen as well.

• 

  Figure 5. Electrocardiogram (ECG) after administration of intracoronary nitroglycerin and resolution of coronary vasospasm. ECG shows resolution of ST segment elevation.

• 

  Figure 6. Initial electrocardiogram (ECG) on the second admission without ischemic changes. Initial ECG on the second admission shows normal sinus rhythm without ST segment changes.

• 

  Figure 7. Electrocardiogram (ECG) shows ST segment elevation after administration of intravenous norepinephrine. ECG shows ST segment elevation in the inferior leads, and reciprocal ST segment depression.

• 

  Figure 8. Electrocardiogram with resolution of the ST segment elevation after stopping norepinephrine and administration of nitroglycerin.