Complete sustained reversal of cyclic ST-segment elevation (coronary cyclic flow variations) by low-dose intravenous nitroglycerin during acute coronary syndrome

J Electrocardiol. 2014 Mar-Apr;47(2):219-22. doi: 10.1016/j.jelectrocard.2013.12.005. Epub 2013 Dec 7.

Abstract

Background: Recurrent ST-segment elevations in acute coronary syndromes have been attributed to coronary cyclic flow variations (CCFVs) possibly due to coronary vasospasm and unstable platelet aggregation in partially occluded arteries.

Methods: We describe the case of a patient with an acute myocardial infarction, recurrent ST-segment elevations and diffuse disease of the left anterior descending artery.

Results: The post-angiography 12-lead continuous ECG monitoring revealed cyclic anterior ST-segment elevations that were completely abolished with continuous intravenous infusion of low-dose isosorbide-dinitrate.

Conclusion: The complete and sustained response to low-dose nitrate suggests that vasoconstriction plays a crucial role to provoke CCFVs. This case underlines the importance of continuous 12-lead ECG monitoring with ST-segment trend analysis in the CCU.

Keywords: Cyclic flow variations; Myocardial infarction; ST-segment monitoring; electrocardiography; nitroglycerin.

Publication types

  • Case Reports

MeSH terms

  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / drug therapy*
  • Aged, 80 and over
  • Coronary Angiography
  • Coronary Circulation / drug effects*
  • Coronary Circulation / physiology
  • Electrocardiography*
  • Humans
  • Male
  • Nitroglycerin / administration & dosage*
  • Platelet Aggregation Inhibitors / administration & dosage
  • Vasodilator Agents / administration & dosage*

Substances

  • Platelet Aggregation Inhibitors
  • Vasodilator Agents
  • Nitroglycerin