case report

Vasospastic Angina following Coronavirus Disease 2019 in a Korean Male: A Case Report

Taesun Kim1, In Joong Song2†, You Jin Kim2†, Soobin Park2†, Hyunhee Choi1, Kyung Soon Hong1, Kyu Tae Park1*

1Division of Cardiology, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea

2Division of Cardiology, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea

Present Position: Senior student, College of Medicine, Hallym University, Chuncheon, Korea

*Corresponding author: Kyu Tae Park, Division of Cardiology, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon 24253, Republic of Korea

Received Date: 02 November 2022

Accepted Date: 07 November 2022

Published Date: 09 November 2022

Citation: Kim T, Song IJ, Kim YJ, Park S, Choi H, et al. (2022) Vasospastic Angina following Coronavirus Disease 2019 in a Korean Male: A Case Report. Ann Case Report. 7: 1028. DOI: https://doi.org/10.29011/2574-7754.101028

Abstract

There is much research on cardiovascular complications associated with coronavirus disease 2019 (COVID-19). However, despite the endothelial dysfunction that can occur after the disease, little is known about COVID-19-related vasospastic angina (VSA). Here, we report the first case of a patient with VSA following COVID-19 in Korea. He reported tight chest pain and dyspnea; however, transthoracic echocardiography, chest computed tomography, and laboratory tests did not reveal abnormalities. He underwent 24-h Holter monitoring, and early-morning electrocardiography showed ST elevation for about 3 min followed by non-sustained ventricular tachycardia for about 5 s. After subsequent recovery of ST change, the patient complained chest pain. We diagnosed him with VSA and prescribed a calcium channel blocker and nitrates, after which his symptoms resolved.

Keywords: Coronavirus disease 2019; Torsade de pointes; Vasospastic angina

Introduction

Various complications of coronavirus disease 2019 (COVID-19) have been observed, [1] including several cardiovascular complications such as myocarditis, pericarditis, heart failure, pulmonary hypertension, acute coronary syndrome, arrhythmia, and venous thromboembolism. [2] In some patients with COVID-19, ST-segment elevation has been observed, occasionally alongside myocardial infarction and non-coronary obstruction. [3] However, reports of vasospastic angina (VSA) in patients with COVID-19 are rare. Here, we present the first case of COVID-19-related VSA in Korea.

Case Description

The patient, a 48-year-old Korean man, had recently recovered from COVID-19 (diagnosed on June 7, 2022), having experienced general weakness but no other specific symptoms. Two weeks after diagnosis with COVID-19, he visited the hospital emergency room with complaints of tight chest pain and dyspnea.

Initial vital signs were stable, with blood pressure of 113/79 mmHg and pulse rate of 50 beats per minute. Physical examination revealed no additional symptoms. There was no family history of cardiovascular disease or sudden cardiac death, nor any recently prescribed medication. Laboratory tests revealed normal levels of cardiac enzymes (creatine kinase-MB, 2.05 ng/mL; troponin I, 4.24 pg/mL). A chest X-ray showed no abnormalities and an electrocardiogram (ECG) showed sinus bradycardia without ST-T changes (Figure 1). Chest computed tomography (CT) showed no pneumonia or other abnormalities. Transthoracic echocardiography for evaluating myopericarditis showed normal left ventricular (LV) systolic function (LVEF 57%) and normal LV wall thickness.


Figure 1: Chest X-ray and ECG and on first day of hospitalization. (A) Chest X-ray showed no cardiomegaly or active lung lesion. (B) ECG, electrocardiogram. ECG showed sinus bradycardia, normal axis, and 55 beats per minute without ST-T changes.

The patient underwent 24-h Holter monitoring for symptoms associated with chest discomfort and presyncope. On the second day of hospitalization, early-morning ECG showed sudden ST elevation for about 3 min followed by non-sustained ventricular tachycardia (NSVT) including torsade de pointes for ~5 s; his ST-T levels then recovered (Figure 2). Twenty minutes after the ECG changes, during recovery from the ST elevation, he reported further chest pain. Coronary CT was performed later that day and showed no significant stenosis in the coronary arteries (Figure 3A). Additionally, cardiac magnetic resonance imaging (MRI) was performed to investigate for myocarditis or pericarditis and showed no major abnormalities in cardiac structure, perfusion, or regional motion (Figure 3B, C). Thus, the patient was diagnosed with VSA and prescribed a calcium channel blocker (CCB) and nitrates as vasodilators. Symptoms improved following the prescription, and there has been no further report of chest pain from the patient since.