PMC3385192_01
Chest skiagram showing pulmonary edema
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Chest skiagram revealed pulmonary edema [Figure 1].
(a) Electrocardiogram showing sinus tachycardia with secondary "ST-T" changes. (b) ECG on the next day showing normal sinus rhythm with "T"-wave inversions in leads I, aVL, V1 and V2, and ST segment elevation with concavity upward in leads II, III, aVF and V5, and V6
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Electrocardiogram [Figure 2a] showed sinus tachycardia with secondary "ST-T" changes. ECG on the next day [Figure 2b] revealed normal sinus rhythm with "T"-wave inversions in leads I, aVL, V1 and V2, and ST segment elevation with concavity upward in leads II, III, aVF and V5, and V6. Echocardiogram demonstrated hypokinesia of interventricular septum and inferior posterior wall with moderate mitral and tricuspid regurgitation and left ventricular ejection fraction (LVEF) 28% [Figure 3a and b].
(a) Echocardiogram (apical four-chamber view) demonstrating hypokinesia of interventricular septum, (b) Echocardiogram (parasternal long axis view M mode) demonstrating hypokinesia of interventricular septum and inferior posterior wall with LVEF 28%
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ECG on the next day [Figure 2b] revealed normal sinus rhythm with "T"-wave inversions in leads I, aVL, V1 and V2, and ST segment elevation with concavity upward in leads II, III, aVF and V5, and V6. Echocardiogram demonstrated hypokinesia of interventricular septum and inferior posterior wall with moderate mitral and tricuspid regurgitation and left ventricular ejection fraction (LVEF) 28% [Figure 3a and b].
Left coronary angiogram showing normal left anterior descending and left circumflex arteries
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Finally, coronary angiogram was performed which revealed normal coronary vessels [Figures 4 and 5] with positive ergonovine and acetylcholine challenge test for coronary artery vasospasm.
Right coronary angiogram showing normal right coronary artery
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Finally, coronary angiogram was performed which revealed normal coronary vessels [Figures 4 and 5] with positive ergonovine and acetylcholine challenge test for coronary artery vasospasm.