PO-01-076 DIAGNOSIS OF CORONARY VASOSPASM PROMPTED BY EPISODIC ST ELEVATION ON A CONSUMER MOBILE ECG DEVICE

Abstract

Mobile ECG-enabled devices are increasingly used by consumers with limited data on sensitivity to detect ischemic ECG changes. Coronary vasospasm is an important cause of sudden cardiac arrest. The aim of this report is to present a case of a man who was determined to have coronary vasospasm resulting in ST elevation and VF. The patient came to medical attention after recording apparent ST elevation on a consumer mobile ECG device. N/A The patient is a 64-year-old man with paroxysmal atrial fibrillation previously treated with catheter ablation with an implantable loop recorder in place. Two weeks prior to his presentation to our institution, he collapsed at church. He was found to be pulseless and underwent bystander CPR. In-field ECG revealed ventricular fibrillation requiring defibrillation (Figure 1A). Subsequent ECG revealed inferior ST elevation. Coronary angiography demonstrated significant stenosis in the left circumflex artery and mild disease in the right coronary artery. Percutaneous coronary intervention of the left circumflex artery was performed with drug eluting stent. The patient was prescribed aspirin, clopidogrel, and metoprolol. Implantable cardioverter defibrillator placement was deferred as his cardiac arrest was felt to be due to an acute coronary syndrome treated with revascularization. Over the subsequent two weeks, the patient reported episodic sensations of chest uneasiness. He recorded a 6 lead ECG on his AliveCor Kardia device at baseline (Figure 1B) and during symptoms (Figure 1C). Exercise treadmill stress testing revealed no evidence of ischemia. Due to ongoing symptoms, he presented to our institution. Baseline ECG was normal. On telemetry, dynamic ST changes were noted with morphology matching the tracing recorded on his Kardia device, followed by degeneration into nonsustained VF (Figure 1D-F). Coronary angiography revealed a patent left circumflex artery stent and stable non-obstructive right coronary artery disease. Echocardiography was normal. Cardiac biomarkers were normal. A diagnosis of coronary vasospasm was made. The patient was managed with amlodipine and isosorbide mononitrate. After an informed discussion, the patient was discharged with a wearable cardioverter defibrillator. He has not had any arrhythmias or ischemic symptoms during follow-up. While typically used to diagnose arrhythmias, mobile ECG monitors may record ischemic electrocardiographic changes. These may assist in the diagnosis of coronary vasospasm.