Fainting After Chest Pain.
Variant angina presenting acute chest pain and ST elevation on electrocardiogram accounts for an underdiagnosed scenario in acute coronary syndrome and contributes to syncope as a consequence of ventricular arrhythmia. Here, we report a case of a 48-year-old man with a recent onset of chest pain and palpitations followed by syncope. Holter monitoring documented 2 episodes of evolving ST elevation associated with non-sustained ventricular tachycardia. Emergent cardiac catheterization indicated insignificant coronary narrowing. A non-invasive brachial artery ultrasound, which demonstrated endothelial dysfunction that was salvaged by exogenic nitrate, was used instead of intracoronary provocation. There was no clinical or electrocardiographic recurrence of variant angina after vasodilator treatment. In conclusion, variant angina represents an important but overlooked etiology for syncope. Holter monitoring facilitates the diagnostic and prognostic assessment in patients with syncope precipitated by chest pain.


BACKGROUND
Flow-mediated vasodilation; Holter monitoring; Variant angina; Ventricular arrhythmia.
Cardiology, Taipei Hospital, New Taipei City;
Ko-Fan
KF
Wang
Cardiology, Taipei Veterans General Hospital;
Chun-Chin
CC
Chang
Cardiology, Taipei Veterans General Hospital;
Chien-Yi
CY
Hsu
Cardiology, Taipei Veterans General Hospital;
Ching-Wei
CW
Lee
Cardiology, Taipei City Hospital, Taipei, Taiwan.
Chung-Hsing
CH
Lin
Cardiology, Taipei Veterans General Hospital;
Chern-En
CE
Chiang