# Exercise-induced coronary spastic angina with an early repolarization pattern diagnosed after cardiopulmonary resuscitation: a case report

## TL;DR

A 36-year-old man experienced cardiac arrest due to exercise-induced coronary spastic angina, diagnosed through cardiopulmonary exercise testing and early repolarization pattern on ECG.

## Contribution

This case highlights the role of cardiopulmonary exercise testing in diagnosing and monitoring exercise-induced coronary spastic angina.

## Key findings

- Cardiopulmonary exercise testing revealed exercise-induced coronary spastic angina with ST elevation and decreased cardiac output.
- Treatment with smoking cessation and drugs improved the patient's cardiac output and prevented ischaemic symptoms during exercise.
- A subcutaneous implantable cardioverter defibrillator was effective for secondary prevention without needing to deliver therapies.

## Abstract

Early repolarization pattern is known to be an independent risk factor of ventricular fibrillation in patients with coronary spastic angina. Additionally, drug provocation tests for coronary vasospasms are highly diagnostic, but negative results cannot completely rule out the presence of coronary spastic angina. We report a rare case of cardiopulmonary arrest with early repolarization pattern in a patient diagnosed with cardiopulmonary exercise testing-induced coronary spastic angina.

A 36-year-old male suffered a sudden cardiac arrest during a football game. After resuscitation, a normal electrolyte balance was confirmed, and both coronary and head computed tomography scans revealed no abnormalities. Sodium channel blocker and electrophysiological tests were negative. The electrocardiogram revealed early repolarization pattern as the only positive finding. After the examination, we implanted a subcutaneous implantable cardioverter defibrillator for secondary prevention. During cardiopulmonary exercise testing to evaluate his exercise tolerance, the patient experienced sudden chest pain and ST elevation on lead aVR when he reached the anaerobic threshold. He had a poor increase in the oxygen consumption/heart rate. This suggested a decreased cardiac output due to an acute ischaemic attack. The patient was diagnosed with exercise-induced coronary spastic angina. After smoking cessation and drug treatment initiation, no ischaemic symptoms appeared at the anaerobic threshold during cardiopulmonary exercise, and his cardiac output improved. The subcutaneous implantable cardioverter defibrillator never needed to deliver any therapies.

This case demonstrated the value of cardiopulmonary exercise testing in diagnosing exercise-induced coronary spasms and its effectiveness in determining the treatment efficacy.