PMC5350487_01
(a) Coronary angiography showed atherosclerotic change with mild stenosis in the left anterior descending artery. (b) Ergonovine provocation induced coronary spasm in the mid-left anterior descending artery (arrows), causing up to 70% stenosis as demonstrated by quantitative coronary analysis.
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CAG showed atherosclerotic change with mild stenosis in the left anterior descending artery (LAD) (Figure 1(a)). Provocation test (60 mug of ergonovine in physiological saline into the left coronary artery over a period of 3 minutes) showed coronary spasm in the mid-LAD causing up to 70% stenosis by quantitative coronary analysis (Figure 1(b)).
(a) Electrocardiography showed ST segment elevation in precordial leads (V2~V6). (b) Coronary angiography revealed neither spastic occlusion nor significant narrowing of coronary arteries.
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Initial ECG showed ST segment elevation in the precordial leads (V2~V6), and ST segment elevation persisted after intravenous infusion of nitroglycerin (Figure 2). The patient was transferred to a cardiac catheter laboratory, but there was neither occlusion nor significant narrowing on coronary arteries (Figure 2).
Transthoracic echocardiography showed an apical hypokinesia with normal left ventricular systolic function (a). Left ventricular outflow tract obstruction was confirmed by color flow acceleration with high-pressure gradient; maximal velocity (Vmax) 3.2 m/s at resting and 5.0 m/s after Valsalva maneuver (b).
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TTE showed an apical hypokinesia with normal range of LV ejection fraction and LVOT obstruction (Figure 3).
Transthoracic echocardiography showed small amounts of pericardial effusion, apical ballooning, and right ventricular collapse at end-diastole.
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TTE revealed a small amount of pericardial effusion with right ventricular collapse during late-diastole and dilated inferior vena cava without respiratory variation (Figure 4).