Abstract
Coronary artery spasm has been reported during adenosine stress testing. Herein, we describe a transient ST-segment elevation following adenosine therapy for supraventricular tachycardia. A 38-year-old male presented to the emergency department with palpitations. Electrocardiogram showed supraventricular tachycardia with short RP interval. Vagal maneuvers were unsuccessful. Adenosine was then administered in two successive injections of 6 and 12 mg dosages, respectively. A subsequent 12-lead electrocardiogram revealed ST-segment elevation in inferior leads with reciprocal changes. Coronary angiography disclosed nonobstructive coronary disease. A postprocedure electrocardiogram exhibited normal sinus rhythm with nonspecific T wave abnormalities. Cardiac biomarkers were elevated with a peak troponin I of 0.32. Echocardiogram depicted bicuspid aortic valve and normal systolic function. Electrophysiological study revealed a concealed left accessory pathway and successful radiofrequency ablation was performed. Given the dynamic changes in the electrocardiogram, we hypothesize that this event was most likely a coronary vasospasm. The mechanism of coronary spasm following adenosine injection remains uncertain. Potential mediators include KATP channels and adenosine-2 receptors.
Highlights
Adenosine is a frequently used pharmacologic stress agent in myocardial perfusion imaging and supraventricular tachyarrhythmia (SVT) termination, known as atrioventricular blocking effect
Adenosine usually has a vasodilator effect in the coronary microcirculation; this case demonstrated an unusual complication of intravenous administration of adenosine, coronary vasospasm
The presence of persistent epigastric pain along with ST-segment elevation with reciprocal changes that were reverted by nitrates was very suggestive of an ischemic event, in which cardiac catheterization did not show significant obstructive coronary artery disease as the cause of the patient symptoms
Summary
Adenosine is a frequently used pharmacologic stress agent in myocardial perfusion imaging and supraventricular tachyarrhythmia (SVT) termination, known as atrioventricular blocking effect. We present a case of ST-segment elevation myocardial infarction following an intravenous bolus dose of adenosine for SVT termination. A 38-year-old Hispanic male, without known cardiovascular diseases presented to the emergency room complaining of two-day history of intermittent palpitations. He stated having a three-hour pressure-like epigastric discomfort with radiation to the right upper quadrant. There was no history of syncopal or presyncopal episodes His past medical history disclosed multiple episodes of palpitations since the age of 20, but no associated chest pain, a syncopal episode related to exercise a year earlier and
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