A case of effort angina pectoris with coronary spastic angina for which 24 hour holter electrocardiography was useful

Abstract

We detected ST elevation in Holter electrocardiography results when symptoms occurred. We encountered the case of a patient who was diagnosed as having effort angina pectoris (EAP) with coronary spastic angina (CSA). The patient was female in her 40s. About a month ago, she began to feel chest zonesthesia that radiated to the neck while resting in the morning, and she underwent Holter electrocardiography. Transient ST elevation with chest symptoms was detected on both NASA and CM5 inductions in the morning. On the other hand, transient ST elevation of a different type with chest symptoms was detected on the NASA induction in the evening on effort. In coronary angiography, mild spasm was found in the entire coronary artery. Stenosis of 99% was found in the anterior descending branch of the left coronary artery (segment 7). From the results of Holter electrocardiography and coronary arteriography, we diagnosed the patient as having EAP with CSA. The patient was treated with catheterization for EAP and calcium antagonists for CSA. Angina generally has EAP and CSA. We learned that we can accurately interpret results by understanding each characteristic and onset pattern if we encounter a relatively rare complication.