Key result
Administration of the calcium antagonist diltiazem abolished exercise-induced cyclic episodes of S-T segment elevation in a patient with variant angina.
Why the study?
Does diltiazem prevent exercise-induced cyclic S-T segment elevation in a patient with variant angina?
Case Report (n=1)
No
Does diltiazem prevent exercise-induced cyclic S-T segment elevation in a patient with variant angina?
This case report demonstrates that exercise-induced cyclic S-T segment elevation in variant angina, likely due to coronary spasm superimposed on a fixed lesion, can be effectively abolished by the calcium antagonist diltiazem.
May suggest diltiazem benefit in exercise-triggered variant angina; hypothesis-generating, should not yet change practice.
A unique case of variant angina is described in which cyclic S-T segment elevation was reproducibly induced by exercise. The treadmill test revealed cyclic S-T segment elevation to occur from the first minute onward, recurring with a cycle length of 2 min throughout the exercise while the work load was being increased. Similar cyclic episodes were also induced by the cold pressor test, and the ambulatory electrocardiogram demonstrated spontaneous episodes of S-T segment elevation with a similar cycle length in early mornings. Coronary arteriography revealed a fixed lesion in the mid-portion of right coronary artery with a 90% narrowing associated with coronary spasm leading to subtotal occlusion. The cyclic episodes were abolished by the administration of the calcium antagonist diltiazem. The spontaneous phasic activity of coronary arterial muscle is discussed as a possible cause or mechanism.
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Sato et al. (1983) conducted a case report in Variant angina (n=1). Diltiazem vs. No treatment (baseline) was evaluated on Occurrence of cyclic S-T segment elevation during exercise. Administration of the calcium antagonist diltiazem abolished exercise-induced cyclic episodes of S-T segment elevation in a patient with variant angina.
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