Published on 02/03/2015 by admin
Filed under Internal Medicine
Last modified 02/03/2015
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Case 7
A 39-year-old woman with a history of hypertension, chronic renal failure (creatinine = 3.1), and remote cocaine abuse was admitted for evaluation of nonexertional dull chest pain. She had a normal coronary angiogram 4 years previously for similar symptoms.
The baseline ECG demonstrates increased QRS voltage consistent with left ventricular hypertrophy (LVH), with nonspecific ST-T abnormalities possibly related to LVH.
The patient complained of mild chest pain near the completion of the adenosine infusion. The ECG tracing obtained at 4 minutes, 50 seconds of the adenosine infusion demonstrated more prominent ST-T abnormalities with T-wave inversions suspicious for (but not diagnostic for) myocardial ischemia. This finding is common in patients with baseline LVH.
The patient described persistent chest pain nearly 6 minutes after completion of the adenosine infusion. This is highly unusual; the side effects of adenosine are typically very short-lived, owing to the very short half-life of adenosine (<10 seconds). An ECG tracing was obtained and demonstrated persistent nonspecific ST-T abnormalities.
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