Chest pain and coronary endothelial dysfunction after recovery from COVID‐19: A case series

Figures

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  FIGURE 1. Exercise Electrocardiographic and SPECT Findings in Patient 1. Panel A shows single‐photon emission computerized tomography (SPECT) images obtained at baseline and after exercise. Note the marked diaphragmatic attenuation that resolves with attenuation correction and leaves a residual apical anterior and septal defect on stress images, consistent with ischemia. (arrows). Panel B shows the baseline electrocardiogram showing normal sinus rhythm. Panel C shows the electrocardiogram during treadmill exercise after 10 min, while the patient reported chest pain. Note the presence of 1.5 mm ST depressions in inferior leads that were not present at baseline (arrows)

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  FIGURE 2. Angiography without and with Acetylcholine Administration and Accompanying Electrocardiographic Changes in Patient 1. Panel A shows the baseline appearance of the left anterior descending artery (arrows) during coronary angiography. Panel B shows the appearance of the left anterior descending artery after intracoronary acetylcholine infusion with severe vasoconstriction of the mid‐ and distal vessel. Panels C (baseline) and D (after acetylcholine) show electrocardiographic findings at the time

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  FIGURE 3. Regadenoson Electrocardiographic and SPECT Findings in Patient 2. Panel A shows single‐photon emission computerized tomography (SPECT) images obtained at baseline and after regadenoson administration. Note a fixed inferolateral defect on non‐attenuation corrected images that resolves with attenuation correction and is consistent with attenuation artifact. Note that attenuation correction creates anteroseptal artifact

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  FIGURE 4. Angiography without and with Acetylcholine Administration and Accompanying Electrocardiographic Changes in Patient 2. Panel A shows the baseline coronary angiogram with a 70% stenosis in the mid‐left circumflex (asterisk) and arrows indicating a diagonal branch and the distal left anterior descending artery. Panel B shows the vasoconstriction of the diagonal branch and the left anterior descending artery after intracoronary acetylcholine infusion with an unchanged stenosis in the left circumflex artery (asterisk). Panels C (baseline) and D (after acetylcholine) show electrocardiograms obtained at the time of cardiac catheterization. Note the ischemic ST‐depression in leads II and V with acetylcholine administration seen in Panel D