title: Complete sustained reversal of cyclic ST-segment elevation (coronary cyclic flow variations) by low-dose intravenous nitroglycerin during acute coronary syndrome.
abstract: BACKGROUND
  Recurrent ST-segment elevations in acute coronary syndromes have been attributed to coronary cyclic flow variations (CCFVs) possibly due to coronary vasospasm and unstable platelet aggregation in partially occluded arteries.
  
  
  METHODS
  We describe the case of a patient with an acute myocardial infarction, recurrent ST-segment elevations and diffuse disease of the left anterior descending artery.
  
  
  RESULTS
  The post-angiography 12-lead continuous ECG monitoring revealed cyclic anterior ST-segment elevations that were completely abolished with continuous intravenous infusion of low-dose isosorbide-dinitrate.
  
  
  CONCLUSIONS
  The complete and sustained response to low-dose nitrate suggests that vasoconstriction plays a crucial role to provoke CCFVs. This case underlines the importance of continuous 12-lead ECG monitoring with ST-segment trend analysis in the CCU.
authors.affiliation: Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Azzarone
authors.affiliation: Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fasulo
authors.affiliation: Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Leuzzi
authors.affiliation: Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tortorella
authors.affiliation: Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy. Electronic address: stefano.savonitto@asmn.re.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Savonitto
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy*; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects* / Q000502:physiology; D004562:Electrocardiography; D006801:Humans; D008297:Male; D005996:Nitroglycerin / Q000008:administration & dosage*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D005996:Nitroglycerin
keywords: Cyclic flow variations; Myocardial infarction; ST-segment monitoring; electrocardiography; nitroglycerin