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Europace Advance Access originally published online on May 21, 2007
Europace 2007 9(8):568-570; doi:10.1093/europace/eum087
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

SYNCOPE

Coronary spasm: a case of transient ST elevation and syncopal ventricular tachycardia without angina

Claudia Postorino, Mark M. Gallagher*, Luca Santini, Giulia Magliano, Gaetano Chiricolo, Missiroli Bindo, Alfredo Postorino and Francesco Romeo

Dipartimento di Cardiologia, Policlinico Tor Vergata, Viale Oxford 81, Rome 00133, Italy

We report the case of a 60-year-old male with recurrent pre-syncope, referred with a provisional diagnosis of carotid sinus syndrome on the basis of a 4 s asystolic pause following carotid sinus massage. On repeat Holter monitoring there was ST-segment elevation followed by episodes of polymorphic ventricular tachycardia during a mild episode of pre-syncope. Coronary angiography showed mild right coronary artery irregularity without significant stenosis. An automatic cardioverter defibrillator was implanted and high dose combined vasodilator therapy was commenced. At follow-up 18 months after implantation, the device has recorded no episode of tachycardia and the patient reports no recurrence of symptoms.

Key Words: Coronary spasm, Sudden death, Ventricular tachycardia, Ventricular fibrillation, Syncope, Carotid sinus syndrome

* Correspondence author: Viale di Villa Massimo 37, Rome 00161, Italy. Tel: +44 7936695891; fax: +39 0620900382. E-mail address: mark_m_gallagher{at}hotmail.com

Manuscript submitted 20 October 2006. Accepted after revision 9 April 2007.


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