What question did this study set out to answer?

To describe a rare presentation of accelerated idioventricular rhythm occurring at the resolution of an acute episode of coronary artery vasospasm.

January 16, 2019CureusOpen Access

Accelerated Idioventricular Rhythm at the Termination of an Episode of Vasospastic Angina

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To describe a rare presentation of accelerated idioventricular rhythm occurring at the resolution of an acute episode of coronary artery vasospasm.
Clinical and diagnostic evaluation of a 57-year-old male presenting with chest pain, syncope, and anterolateral ST-segment elevation.
Comprehensive diagnostic assessment utilizing serial cardiac biomarkers, 12-lead electrocardiography, coronary angiography, echocardiography, and cardiac MRI.
Initial diagnostic investigations revealed negative myocardial injury biomarkers and entirely unremarkable coronary angiography, echocardiography, and cardiac MRI findings.
A recurrent in-hospital episode of chest pain accompanied by ST-segment elevation culminated in a transient run of accelerated idioventricular rhythm that resolved following sublingual nitroglycerin administration.

Structured PICO

Population

1 57-year-old male with gastroesophageal reflux disease and esophageal stricture presenting with anterolateral ST-segment elevation myocardial infarction and syncope.

Intervention

Sublingual nitroglycerin

Outcome

Termination of accelerated idioventricular rhythm (AIVR)

This case highlights a unique presentation of accelerated idioventricular rhythm following an episode of Prinzmetal's angina that was terminated by sublingual nitroglycerin.

Implication

Esophageal stricture may mimic STEMI with negative workup; leaves open expanded differentials for catheterization activations.

Abstract

A 57-year-old male with gastroesophageal reflux disease and esophageal stricture with dilation presented as a cardiac catheterization lab activation for anterolateral ST-segment elevation myocardial infarction. He had suffered an unwitnessed syncopal episode after severe substernal chest pain. Electrocardiogram (ECG) showed anterolateral ST-segment elevation. Markers of myocardial injury were negative. He subsequently had an unremarkable coronary angiogram, echocardiogram, and cardiac magnetic resonance imaging (MRI). He had another episode of crushing chest pain and palpitations during his hospital stay, which correlated with ST-segment elevation, followed by a slow run of ventricular arrhythmia that terminated after a dose of sublingual nitroglycerin. A diagnosis of accelerated idioventricular rhythm (AIVR) following coronary artery vasospasm (CAV) was made. This clinical vignette presents a unique presentation of AIVR following an episode of Prinzmetal's angina.