Abstract
Exercise-induced vasospastic angina (EIVA) is a relatively rare disease reported to be recognized in about 40% of vasospastic angina. EIVA must be differentiated from common effort angina irrelevant to circardian rhythm. We report the case of a 61-year-old male with an angina episode with ST segment elevation in ECG during a treadmill exercise test. A significant vasospasm of the right coronary artery was demonstrated by coronary angiography and intracoronary injection of methylergometrine maleate. These findings suggest that the expected mechanism of EIVA might be ascribed to increased sympathetic tone in the morning closely associated with circadian variation, endothelial vascular dysfunction in the epicardial coronary artery, and smoking. Moreover, determination of when EIVA occured may be very supportive in the diagnosis of EIVA. As a result, recalling EIVA may lead to a reduction in unfavorable complications when the exercise stress test is carried out to diagnose EIVA.
