Bradycardia in Intermediate Coronary Syndrome

To the Editor: I read in the excellent article of Fischl et al. in the June 7 issue that all their 23 patients with the intermediate coronary syndrome had sinus tachycardia and ST-segment or T-wave changes. This is indeed true in the great majority of patients. However, I have recently seen 2 patients with symptoms satisfying the clinical criteria as set by Fischl and his co-workers in whom the only early electrocardiographic abnormality was sinus bradycardia. In one case sinus tachycardia at a rate of 110 per minute spontaneously occurred 48 hours later. In both patients coronary-artery disease was documented ….