Combined anterior and inferior ST-segment elevation during exercise test: a case report

Exercise-induced ST-segment elevation without Q waves is a rare situation. Its frequent causes are slow coronary flow leading to serious myocardial ischemia, significant coronary stenosis, and coronary vasospasm. Effort-related combined anterior and inferior ST elevation is even rarer. A 49-year-old man was admitted with exercise-induced chest pain. During exercise stress test, he developed typical retrosternal chest pain with combined anterior and inferior ST elevation on electrocardiography. Coronary angiography showed an anomalous left circumflex coronary artery arising from the right sinus of Valsalva. A plaque and diffuse spasm were noted in the middle portion of the left anterior descending coronary artery. Intracoronary nitroglycerin administration resulted in complete resolution of the spasm. The patient was discharged on medical therapy.