Acute ischemia manifestation in a patient with coronary slow flow phenomenon.

A patient with anginal chest pain and electrocardiographic changes suggesting ischemia was referred to our hospital. Coronary angiography revealed no significant stenosis or ectasia but only slow flow in all 3 coronary arteries. After infusion of unfractionated heparin for 24 hours, negative T waves became less deep, and repeated coronary angiography showed significant improvement of the coronary flow. The coronary slow flow phenomenon, together with the associated ischemic electrocardiographic changes, should be considered as a separate entity in the differential diagnosis of acute coronary syndromes. Additional clinical research is required to better understand the syndromes of chest pain with normal coronary arteries.