Exercise-induced S-T segment elevation in variant angina.

Five patients with known ischemic heart disease had an unusual pattern of S-T segment depression during treadmill exercise testing followed by S-T segment elevation and chest pain in the postexercise period. Thallium-201 scintigraphy revealed reversible exercise-induced myocardial ischemia, in areas supplied by severely narrowed coronary arteries as documented by coronary arteriography. Ambulatory electrocardiographic recording for S-T segment shift using a frequency-modulated system showed S-T segment depressions and elevations at rest in the same leads that showed similar shifts during exercise tests. Three of the five patients had a myocardial infarction within 8 weeks of diagnosis, and two died. This syndrome may be associated with severe coronary artery disease and may have a very poor prognosis.