Korean Circ J.  2016 Jan;46(1):102-106. 10.4070/kcj.2016.46.1.102.

Ventricular Tachycardia Associated Syncope in a Patient of Variant Angina without Chest Pain

• Kim SJ
• Juong JY
• Park TH

• KMID: 2223776
• DOI: http://doi.org/10.4070/kcj.2016.46.1.102

Abstract

A 68-year-old man was admitted for a syncope workup. After routine evaluation, he was diagnosed with syncope of an unknown cause and was discharged from the hospital. He was readmitted due to dizziness. On repeated Holter monitoring, polymorphic ventricular tachycardia was detected during syncope. We performed intracoronary ergonovine provocation test; severe coronary spasm was induced at 70% stenosis of the proximal left anterior descending artery. The patient was treated with percutaneous coronary intervention. We present a rare case of syncope induced by ventricular arrhythmia in a patient with variant angina without chest pain.

Keyword

Prinzmetal's variant angina; Coronary vasospasm; Tachycardia, ventricular

MeSH Terms

Aged
Arrhythmias, Cardiac
Arteries
Chest Pain*
Constriction, Pathologic
Coronary Vasospasm
Dizziness
Electrocardiography, Ambulatory
Ergonovine
Humans
Percutaneous Coronary Intervention
Spasm
Syncope*
Tachycardia, Ventricular*
Thorax*
Ergonovine

Figure

• 

  Fig. 1 Initial coronary angiography reveals 70% narrowing of proximal LAD (A) and the stenosis is persistent after intracoronary nitrates administration (B). Follow up coronary angiography with spasm provocation test shows nearly total occlusion at 70% narrowed proximal LAD (C). Coronary stenting was performed and coronary angiography shows normalized proximal LAD lumen (D). LAD: left anterior descending artery.

• 

  Fig. 2 Channels 1, 2, and 3 of Holter electrocardiogram (ECG) are regarded as lead V1, V6, and II of the 12 lead ECG, respectively. Forty eight hour Holter monitoring analysis reveals normal ST-segment before development of arrhythmia (A). However, during the syncope episode ST-segment elevation (arrows) is followed by premature ventricular complexes (PVCs) (B). Polymorphic ventricular tachycardia starts with the PVCs (C) and degenerates into ventricular fibrillation (D).

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