Intravenous atropine relieves coronary arterial spasm and hemodynamic decompensation during recovery after exercise

A 66-year-old man developed right coronary arterial spasm and hemodynamic d ecompensation during the early recovery phase of a treadmill exercise test. The unstable condition was corrected immediately after intravenous adminis tration of atropine. A subsequent coronary angiographic study revealed insi gnificant right coronary artery stenosis. The pathophysiology of this respo nse may be related to rapid alterations in autonomic balance during recover y after exercise. To our knowledge, this is the Ist reported case in which atropine effected immediate reversal of coronary arterial spasm and hemodyn amic decompensation that were induced by exercise, rather than by pharmacol ogic agents. Atropine might be an effective treatment in patients who exper ience exercise-induced coronary arterial spasm and hemodynamic decompensati on, but further investigation is warranted.