Hyperventilation-Induced Coronary Vasospasm in an Asthmatic Patient With ST-Segment Elevation and Intramyocardial Hematoma.

BACKGROUND

Coronary vasospasm may lead to myocardial injury even in the absence of obstructive coronary artery disease. Diagnostic clarity can be enhanced through multimodality imaging and appropriate provocation testing.

CASE SUMMARY: We present a case of a 64-year-old man who developed transient ST-segment elevations during an asthma exacerbation. Coronary angiography showed nonobstructive disease, whereas echocardiography and cardiac magnetic resonance imaging revealed an intramyocardial hematoma. Hyperventilation provocation testing, both invasive and noninvasive, confirmed coronary vasospasm. Optical coherence tomography demonstrated multilayered, healed plaques. The patient was also diagnosed with pulmonary tuberculosis, which may have played a contributory role.

DISCUSSION: To our knowledge, this is the first reported case of concurrent coronary vasospasm, intramyocardial hematoma, and active tuberculosis. This case report highlights the diagnostic value of hyperventilation testing when acetylcholine is unavailable.

TAKE-HOME MESSAGES: Intramyocardial hematoma may result from recurrent vasospasm induced by asthma-related hyperventilation, with tuberculosis as a possible contributing factor. Hyperventilation testing may be a practical alternative for diagnosing coronary vasospasm when acetylcholine is unavailable.