Fainting after chest pain

Ko Fan Wang, Chun Chin Chang, Chien Yi Hsu, Ching Wei Lee, Chung Hsing Lin, Chern En Chiang

Research output: Contribution to journalArticlepeer-review


Variant angina presenting acute chest pain and ST elevation on electrocardiogram accounts for an underdiagnosed scenario in acute coronary syndrome and contributes to syncope as a consequence of ventricular arrhythmia. Here,we report a case of a 48-year-old manwith a recent onset of chest pain and palpitations followed by syncope. Holter monitoring documented 2 episodes of evolving ST elevation associated with non-sustained ventricular tachycardia. Emergent cardiac catheterization indicated insignificant coronary narrowing. A non-invasive brachial artery ultrasound, which demonstrated endothelial dysfunction that was salvaged by exogenic nitrate, was used instead of intracoronary provocation. There was no clinical or electrocardiographic recurrence of variant angina after vasodilator treatment. In conclusion, variant angina represents an important but overlooked etiology for syncope. Holter monitoring facilitates the diagnostic and prognostic assessment in patients with syncope precipitated by chest pain.

Original languageEnglish
Pages (from-to)215-225
Number of pages11
JournalActa Cardiologica Sinica
Issue number3
Publication statusPublished - Jan 1 2015
Externally publishedYes


  • Flow-mediated vasodilation
  • Holter monitoring
  • Variant angina
  • Ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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