Fluctuations in the amplitude of ST-segment elevation in vasospastic angina: Two case reports

RATIONALE: ST-segment elevation localizes an ischemic lesion to the coronary artery supplying the area of the myocardium reflected by the electrocardiographic leads. Dynamic ST-segment elevation can be due to severe transmural ischemia secondary to a thrombus, vasospasm, or a tightly fixed coronary artery lesion or a combination of these situations. PATIENT CONCERNS: In this study, we report on two patients with angina who had fluctuations in ST-segment amplitude on serial electrocardiograms. The amplitude of ST-segment elevation varied between 1-20 mm. DIAGNOSES: Vasospastic angina (VSA) was diagnosed based on electrocardiography and coronary angiography. INTERVENTIONS: Calcium antagonists were prescribed for both patients. OUTCOMES: No recurrent VSA was noted during outpatient follow-up. LESSONS: VSA can be associated with fluctuations in the amplitude of ST-segment elevation, indicating dynamic coronary vasospasm in different locations and extensions in patients with VSA.