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Inappropriate microvascular constriction produced transient ST-segment elevation in patients with syndrome X

^a Department of Cardiology, Tenshi Hospital (Franciscan Mission of Mary), Sapporo, Japan

View larger version (53K): [in a new window]   Figure 1 Serial electrocardiographic changes in case 1. (A) Control electrocardiography at rest: (B) the transient ST-segment elevation; (C) after a 0.5-mg infusion of intracoronary NTG; (D) after a 10-mg infusion of intracoronary PVN.

View larger version (63K): [in a new window]   Figure 2 Serial electrocardiographic changes and coronary angiograms in case 2. (A) Control electrocardiography at rest; (B) the transient ST-segment elevation; (C) a control coronary angiogram; (D) a coronary angiogram during the ST-segment elevation.

View larger version (69K): [in a new window]   Figure 3 Serial electrocardiography changes and coronary angiograms in case 3. (A) Control electrocardiography at rest. This electrocardiographic was obtained at the end of cardiac catheterization because ST-segment changes (B and C) were observed just after cardiac catheterization was begun. (B) A transient ST-segment depression; (C) the transient ST-segment elevation; (D) a control coronary angiogram; (E) a coronary angiogram during the ST-segment elevation.

View larger version (104K): [in a new window]   Figure 4 Coronary angiograms of the left coronary artery in case 1. (A) A control coronary angiogram; (B) a coronary angiogram during the ST-segment elevation; (C) a coronary angiogram after a 0.5-mg intracoronary NTG infusion; (D) a coronary angiogram after a 10-mg intracoronary PVN infusion.

View larger version (75K): [in a new window]   Figure 5 Representative CBF profile of the LAD with a Doppler guide wire in case 1. (A) During the ST-segment elevation; (B) after an intracoronary infusion of 0.5 mg of NTG; (C) after an intracoronary infusion of 10 mg of PVN.

View larger version (73K): [in a new window]   Figure 6 Representative light microscopic sections from the right ventricular myocardium with hematoxylin and eosin stain in case 1. (A) Typical perivascular fibrosis and fibromuscular dysplasia of the media were demonstrated (x400); (B) focal interstitial fibrosis and perinuclear halo of the myocardium were observed (x400).