PMC5866855_01
ECG on admission showing fast atrial fibrillation.
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ECG on presentation showed fast atrial fibrillation with a ventricular rate of 156 beats per minute (Figure 1).
An immediate 12-lead ECG recorded atrial fibrillation with bradycardia and ST elevation in leads II, III, avF, and V1-V4 with ST depression in I, aVL, and V5-V6.
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fig2
An immediate ECG revealed marked ST segment elevation in leads II, III, aVF, and V1-V4 with ST depression in I, aVL, and V5-V6 with atrial fibrillation and bradycardia (Figure 2).
(a) Left coronary artery: diffuse coronary spasm involving proximal to distal of left anterior descending artery. (b) Right coronary artery: diffuse coronary spasm involving proximal to distal of right coronary artery, posterior descending artery, and posterior left ventricular branch. (c) Left coronary artery vasospasm resolved after intracoronary nitroglycerin. (d) Right coronary artery vasospasm resolved after intracoronary artery nitroglycerin.
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Diffuse small caliber vessels were demonstrated in the left coronary artery (Figure 3) and the right coronary artery (Figure 3). Following intracoronary injection of 200 mcg nitroglycerin, the caliber of the vessel improved significantly as visualized in Figure 3 for the left coronary artery and Figure 3 for the right coronary artery.