Coronary Vasospasm While Treating Supraventricular Tachycardia : Is Adenosine Really to Blame?

Abstract EN

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.