Transient silent ischemia after PTCA manifested with a bizarre ECG

Silent myocardial ischemia (SMI) is defined as a transient alteration in myocardial perfusion in the absence of chest pain or the usual anginal equivalents. SMI is recognized as a common manifestation after percutaneous coronary interventions (PCIs) (1-2). PCIs can induce coronary artery spasm that causes ischemia (2). As catheterization laboratory procedures have become progressively more invasive with multivessel interventions, prolonged balloon inflation times, use of multiple guiding catheters and the advent of coronary stenting, the propensity for PCI-induced spasm has increased. We report a patient who had a brief period of intense epicardial ischemia after percutaneous transluminal coronary angioplasty (PTCA), possibly due to coronary artery spasm. Although this clinical picture is not unusual, the authors find the ECG changes during SMI very exceptional.