Prognostic aspects of early repolarization syndrome and vasospastic angina combination for life-threatening heart rhythm disorders prevention

Early repolarization syndrome was initially considered to be a normal variant, until the cases of sudden cardiac death in seemingly healthy people were described in the literature. A clinical case of a combination of vasospastic angina with this syndrome in a 44 years old patient is presented. The patient complained of nocturnal angina pectoris attacks corrected by nitrates. Early repolarization syndrome was revealed on the resting electrocardiogram (ECG) in the lateral leads. During the Holter ECG monitoring, episodes of ST-T elevation on the V5 channel up to 3.5 mm and on the avf channel up to 2.5 mm have been recorded, accompanied by complaints of chest pain based on the diary data. Thus, the heart rate at the time of the attack did not exceed 68 beats per minute. This allowed to exclude tachy-dependent character of ischemia. A pronounced spasm was revealed in response to the contrast medium injection without atherosclerotic lesion of coronary arteries when performing coronarography. The presented case demonstrates the need for an in-depth examination of patients with early polarization syndrome regardless of age, with a view to the possible detection of vasospastic angina and the prevention of arrhythmogenic complications, which are highly probable.