Department of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan, China (mainland).
Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China (mainland).
Am J Case Rep. 2023 Oct 28;24:e941692. doi: 10.12659/AJCR.941692.
BACKGROUND Although coronary artery disease and coronary artery spasm (CAS) can lead to acute myocardial infarction, there are clear differences in treatment between coronary heart disease and CAS, and the therapeutic schedule should not be confused. Furthermore, electrocardiogram (ECG) "6+2" phenomenon is recommend as a specific ECG indicator for lesions in the left main coronary artery or multiple vessels. Currently, no reports of this phenomenon in CAS exist. CASE REPORT A 72-year-old man had history of recurrent chest pain for over 6 years, with episodes lasting about 10 min and resolving with rest. He experienced symptom recurrence and exacerbation due to substance abuse. He was admitted to our Emergency Department for chest pain at rest. His emergency ECG revealed a 6+2 phenomenon, accompanied by troponin levels exceeding 18 times the reference value. Promptly, we conducted coronary angiography, with unexpected normal findings. Following thorough assessment, we postulated the patient could have CAS. Subsequent to medical team intervention, the patient's ECG normalized, leading to his discharge upon condition stabilization. CONCLUSIONS We report a case of CAS in a patient with ECG 6+2 phenomenon, without significant coronary artery stenosis. This differs from transient ST-segment elevation on ECG, a well-recognized hallmark of CAS; however, such a presentation has not been documented before. Additionally, treatment strategies for myocardial ischemic conditions stemming from coronary atherosclerosis diverge from those employed for CAS. Therefore, clinicians should advocate for coronary angiography whenever feasible. This approach serves to elucidate the underlying disease etiology and facilitates the administration of precision-targeted interventions for patients.
尽管冠状动脉疾病和冠状动脉痉挛（CAS）均可导致急性心肌梗死，但冠心病和 CAS 的治疗方法有明显差异，不应混淆治疗方案。此外，心电图（ECG）“6+2”现象被推荐为左主干冠状动脉或多支血管病变的特定 ECG 指标。目前，尚无 CAS 中存在此现象的报告。
一名 72 岁男性反复胸痛 6 年以上，每次发作持续约 10 分钟，休息后缓解。因滥用药物，他的症状复发并加重。他因胸痛在我院急诊就诊。他的急诊心电图显示 6+2 现象，同时肌钙蛋白水平超过参考值的 18 倍。我们迅速进行了冠状动脉造影，结果出人意料地正常。经过全面评估，我们推测患者可能患有 CAS。经过医疗团队的干预，患者的心电图恢复正常，病情稳定后出院。
我们报告了一例心电图 6+2 现象的 CAS 患者，无明显冠状动脉狭窄。这与心电图上公认的 CAS 特征性表现一过性 ST 段抬高不同，但以前没有记录过这种表现。此外，源于冠状动脉粥样硬化的心肌缺血的治疗策略与 CAS 不同。因此，只要可行，临床医生应提倡进行冠状动脉造影。这种方法有助于阐明潜在的疾病病因，并为患者提供精确靶向干预。
