Case Of Coronary Artery Spasm Research Articles

Exploring the ECG "6+2" Phenomenon in Coronary Artery Disease and Coronary Artery Spasm: A Case Report Analysis and Treatment Implications.

BACKGROUND Although coronary artery disease and coronary artery spasm (CAS) can lead to acute myocardial infarction, there are clear differences in treatment between coronary heart disease and CAS, and the therapeutic schedule should not be confused. Furthermore, electrocardiogram (ECG) "6+2" phenomenon is recommend as a specific ECG indicator for lesions in the left main coronary artery or multiple vessels. Currently, no reports of this phenomenon in CAS exist. CASE REPORT A 72-year-old man had history of recurrent chest pain for over 6 years, with episodes lasting about 10 min and resolving with rest. He experienced symptom recurrence and exacerbation due to substance abuse. He was admitted to our Emergency Department for chest pain at rest. His emergency ECG revealed a 6+2 phenomenon, accompanied by troponin levels exceeding 18 times the reference value. Promptly, we conducted coronary angiography, with unexpected normal findings. Following thorough assessment, we postulated the patient could have CAS. Subsequent to medical team intervention, the patient's ECG normalized, leading to his discharge upon condition stabilization. CONCLUSIONS We report a case of CAS in a patient with ECG 6+2 phenomenon, without significant coronary artery stenosis. This differs from transient ST-segment elevation on ECG, a well-recognized hallmark of CAS; however, such a presentation has not been documented before. Additionally, treatment strategies for myocardial ischemic conditions stemming from coronary atherosclerosis diverge from those employed for CAS. Therefore, clinicians should advocate for coronary angiography whenever feasible. This approach serves to elucidate the underlying disease etiology and facilitates the administration of precision-targeted interventions for patients.

Case report: Coronary artery spasm during coronary angiography leading to faulty decision

Abstract:
 Coronary artery spasm defined as constriction of coronary artery segment either focal or diffuse, may be single or multiple. Which is reversible and cause myocardial ischemia by restricting coronary blood flow and may lead to thrombus formation. We present a case of coronary artery spasm that lead to CABG and was discovered after CABG.

Coronary artery spasm due to acute myocarditis in an adolescent: a case report

BackgroundMyocarditis refers to the inflammation of the myocardium caused by infection or autoimmune disease that may or may not present with clinical manifestations, such as gastrointestinal symptoms, dyspnea, chest pain, or sudden death. Although myocarditis and coronary artery vasospasm may mimic ST-segment elevation myocardial infarction (STEMI) with normal coronary arteries on angiography, acute myocarditis rarely causes coronary artery spasm. Here, we report a case of coronary artery spasm with reversible electrocardiographic changes mimicking STEMI in an adolescent with acute myocarditis.Case presentationA 15-year-old boy present with sudden-onset repeated chest pain following a 3-day history of flu-like illness. Cardiac biomarkers were significantly elevated. Electrocardiography showed ST-segment elevation in the absence of detectable vasospasm on coronary angiography. These findings were consistent with the diagnosis of coronary artery spasm secondary to acute myocarditis. Treatment with immunoglobulin for 2 days improved his condition. The patient was discharged on the 12th day with complete resolution of symptoms and normalization of electrocardiogram findings.ConclusionsWe reported a case of coronary artery spasm due to acute myocarditis. This study highlights the importance of considering coronary artery spasm due to acute myocarditis as a differential diagnosis in patients presenting with signs of STEMI as these diseases have different medical management strategies.

Severe coronary artery spasm during left atrial appendage closure plus catheter ablation for atrial fibrillation: case presentation

BackgroundLeft atrial appendage closure (LAAC) combined with radiofrequency catheter ablation (RFCA) as a hybrid procedure is commonly performed to treat atrial fibrillation (AF). Although this treatment carries a low risk of coronary artery spasm (CAS), and has never been observed in LAAC procedure, caution still needed to be taken. We presented a case of CAS that occurred in an AF patient during the hybrid procedure.Case presentationThe patient was a 65-year-old man with paroxysmal AF who developed CAS during RFCA and LAAC. In this case, LAAC was performed ahead of RFCA. After atrial septal puncture, the occluder was advanced into left atrium through delivery sheath, and successfully deployed in the LAA. After verifying the assessment of “PASS” criteria, we decided to release the device. However, before releasing the occluder in LAAC, the patient’s blood pressure (BP) fell to 70/45 mmHg with heart rate (HR) drop and ST-segment elevation in II, III, and aVF and reciprocal ST-segment depression in I and aVL. Isotonic sodium chloride load was administered. After 3 min, the BP and HR raised, and ST-segment returned to normal. The occluder was successfully released after the stable condition of the patient. Then, RFCA was sequentially performed. When isolating the right pulmonary veins, the patient’s BP and HR fell again with ST-segment elevation in inferior leads. Spontaneous ventricular tachycardia and fibrillation developed rapidly and defibrillation was performed immediately with success. Coronary angiography revealed the obstruction of the right coronary artery which disappeared completely after intracoronary nitroglycerin injection (1 mg). Under systemic diltiazem infusion, the RFCA procedure was accomplished. After the procedure, the patient recovered without any neurologic deficit, and CAS has never recurred with isosorbide mononitrate treatment during follow-up.ConclusionsCAS is a rare complication associated with AF hybrid procedure. Attention should be paid to this rare but potentially life-threatening complication.

CASE OF CORONARY ARTERY SPASM WITH FATAL OUTCOME IN THE EARLY PERIOD AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY OF THE RIGHT CORONARY ARTERY WITH IMPLANTATION OF BARE METAL STENTS

The paper presents a clinical case of coronary artery spasm after implantation of bare metal stents. The 60-year-old man was admitted to the hospital with the progression of the coronary heart disease and high angina pectoris functional class for coronary angiography. The patient had the main predisposing factor for the development of coronary artery spasm, which is 20-year smoking history. Based on the results of the coronary angiography, the decision was made to conduct endovascular treatment. The patient was discharged on the 2 nd day after angioplasty with implantation of two stents in the right coronary artery. On the evening of discharge, the man developed a severe pain attack in the epigastric region and turned to the hospital. The electrocardiogram revealed ST-segment elevation in leads II, III, aVF, T-waves were negative in leads I, aVL and V3-6. Repeat coronary angiography showed the stent implantation sites were passable, there was a pronounced diffuse coronary artery spasm, which could not be eliminated by intracoronary administration of nitroglycerin. Coronary artery spasm induced by coronary angioplasty with stent placement is a rare complication that can develop at different time intervals after endovascular intervention. Based on the presented clinical case, it appears likely that even after bare metal stents implantation, the development of endovascular dysfunction leading to coronary spasm is possible.

Reversible Cerebral Vasoconstriction Syndrome Associated with Coronary Artery Vasospasm

Reversible cerebral vasoconstriction syndrome is a rare disorder associated with neurologic symptoms secondary to diffuse cerebral vasospasm. Cardiac involvement in this disease is exceedingly rare. A 50-year-old woman was admitted to our hospital for evaluation of chest pain. During a 3-year period, she had been admitted multiple times because of chest pain and elevated serum cardiac enzymes. Transthoracic echocardiograms showed transient wall-motion abnormalities; however, coronary angiograms revealed no coronary artery disease. At the current admission, she had a thunderclap headache, and cerebral angiograms revealed diffuse cerebral vasoconstriction that improved after verapamil infusion, confirming the diagnosis of reversible cerebral vasoconstriction syndrome. The patient was treated successfully with oral diltiazem and had no recurrence of symptoms. We describe what we think is the first reported case of coronary artery spasm in association with reversible cerebral vasoconstriction syndrome. Future research should be focused on identifying treatment options and defining the mechanisms by which the cerebral and coronary vasculature are affected.

Case report: life-threatening coronary artery spasm under transversus abdominis plane block in combination with general anesthesia

BackgroundMany cases of coronary artery spasm (CAS) during general plus epidural anesthesia have been reported. But transversus abdominis plane(TAP) block in combination with general anesthesia has not been reported to be a cause of CAS, let alone a life-threatening CAS.Case presentationIn this case report, we present a case of a patient with CAS accompanied by ventricular fibrillation under general anesthesia with TAP block.ConclusionCoronary artery spasm, even life-threatening CAS, may occur during TAP block in combination with general anesthesia.

A case of coronary artery spasm induced by epinephrine use during dental treatment

A case of coronary artery spasm induced by epinephrine use during dental treatment

Variant angina associated with myocardial bridging and obstructive sleep apnea syndrome after lumbar spine surgery.

Variant angina associated with myocardial bridging and obstructive sleep apnea syndrome after lumbar spine surgery.

A case of coronary artery spasm caused by manipulation of the neck: heart rate variability analysis

A 66-year-old man with no history of ischemic heart disease underwent cervical lymph node dissection. General anesthesia was induced and maintained with remifentanil, along with propofol. With manipulation of the neck and a subcutaneous injection of lidocaine supplemented with adrenaline before the operation, a sudden decrease in blood pressure (BP) and elevation of the ST-T segment appeared on the monitoring electrocardiogram (ECG). Ephedrine, phenylephrine, adrenaline, and nitroglycerin were administered; however, the hypotension was sustained and the ECG abnormalities progressed, along with further elevation of the ST-T segment and a complete atrioventricular block. Following an injection of atropine, the changes in ECG and BP were attenuated. Heart rate variability (HRV) was analyzed using fully recorded monitor variables, and revealed an increase in the high-frequency domain at the time of the cervical manipulation, suggesting simultaneous vagal stimulation and coronary artery spasm. We concluded that the cervical manipulation had increased the vagal tone and we note that HRV analysis was useful to interpret this coronary event.

Asymptomatic Coronary Artery Spasm and Severe Ventricular Arrhythmias

SUMMARY 2010;78:445-448 Coronary artery spasm generally evolves with episodes of chest pain and ST elevation. However, there are cases of coronary artery spasm without chest pain with documented ventricular tachyarrhythmias. Its incidence is unknown and it should be included in the differential diagnosis of idiopathic ventricular tachycardia or fibrillation. The case of a patient with history of two syncopal episodes with no apparent structural heart disease is described in this work. Continuous ECG monitoring revealed episodes of ST elevation that led to polymorphic ventricular tachycardia. With the diagnosis of asymptomatic coronary artery spasm, a treatment with calcium channel blockers was begun and an automatic implantable cardioverter defibrillator was implanted. R EV A RGENT C ARDIOL

Refractory case of coronary artery spasm with interesting findings: A case report

This is a case of refractory vasospastic angina with unusual electrocardiographic findings and rare coronary angiographic documentation of diffuse spasm of the left coronary system with a baseline of near normal coronary arteries. A 66-year-old man presented with severe vasospastic angina that eventually progressed to non-ST elevation myocardial infarction (NSTEMI). During the episodes of chest pain, the electrocardiogram revealed ST segment depression rather than elevation. Coronary angiography revealed near normal coronary arteries with initial diffuse spasm of the left coronary system. The patient continues to be symptomatic despite treatment with different forms and doses of nitrates and calcium channel blockers.

Angiographic documentation of coronary artery spasm induced by anesthesia

Many cases of coronary artery spasm during regional or general anesthesia have been reported. To our knowledge, for the first time we report a case of coronary artery spasm induced by general anesthesia that was documented by immediate angiography and treated with intracoronary nitroglycerine. A 68-year-old female was to undergo elective cholecystectomy. General anesthesia was induced by propofol 140 mg, fentanyl 50 microg, and vecuronium bromide 7 mg. Immediately after intubation sudden hypotension (60/40 mmHg) and marked ST-segment elevation on the monitor were noticed. A 12-lead electrocardiogram demonstrated marked ST-segment elevations in inferior leads with reciprocal changes. An immediate diagnostic coronary angiography showed diffuse severe narrowing of the right coronary artery with a non-critical plaque in the midportion. After intracoronary administration of nitroglycerine 0.2 mg into the right coronary artery, there was marked diffuse vasodilatation. A diagnosis of variant angina was made and 2 days of hospital course was uneventful. The patient was discharged taking diltiazem 120 mg two times daily, aspirin 100 mg daily and isosorbidemononitrate 60 mg daily.

A case of coronary artery spasm associated with nicorandil-induced anaphylactic shock

A case of coronary artery spasm associated with nicorandil-induced anaphylactic shock

Choc cardiogénique après ingestion d’amphétamines sur un terrain de myocardite à Mycoplasme

Amphetamines are considered as narcotics in France. Their use induces modifications of the central nervous system and of the cardiovascular, respiratory and urinary systems by a sympathomimetic indirect effect. Here is reported the observation of a young woman who absorbed amphetamines causing a cardiogenic shock on a ground of acute myocarditis. The constitution of haemodynamic, respiratory and neurologic distresses lead to the endotracheal intubation of the patient. The haemodynamic status remaining shaky, despite the use of vasoactive drugs, a circulatory assistance by intra-aortic counter pulsation balloon was carried out. The initial echocardiography showed a left ventricular ejection fraction lower than 20%. Amphetamine's toxicity mechanisms still remain complicated; on cardiovascular plan, some cases of coronary artery spasm have been described. The coronarography, not accomplished immediately, was normal. Toxicological samples revealed an abnormally high amphetamines concentration. The severity of the cardiac attack was amplified by a Mycoplasma pneumoniae myocarditis. There was a positive evolution in eight days. Intoxication and infection can difficultly be dissociated in this case of cardiogenic shock.

心拍動下冠動脈バイパス術中に薬剤溶出性ステント留置冠動脈にスパスムを来した１例

心拍動下冠動脈バイパス術中に薬剤溶出性ステント留置冠動脈にスパスムを来した１例

Coronary artery spasm following aortic valve replacement

The authors present a clinical case of coronary artery spasm in a 62-year-old woman undergoing elective aortic valve replacement surgery for aortic regurgitation. On admission at ICU, the patient developed marked hemodynamic and electrical instability. Emergent coronary angiography demonstrated a pronounced spasm of the distal portion of the right coronary artery, apparently related to compression of this vessel by a chest drain tube.

Coronary Artery Spasm as a Cause of Droperidol-Induced Ventricular Fibrillation

To the Editor: Droperidol has been scrutinized for its potential arrhythmogenicity (1). This report describes a case of coronary artery spasm as a possible cause of droperidol-induced ventricular fibrillation. A 60-yr-old man with no history of cardiac disease underwent ileocecectomy to treat ileocecal lymphoma. He was receiving no medications, and was healthy other than the lymphoma. His preoperative 12-lead electrocardiogram showed QT prolongation with a QTc of 452 ms. Anesthesia was induced with 4.0 mg midazolam, 0.5 mg atropine, 200 μg fentanyl citrate, and 12 mg vecuronium bromide, and maintained with 50% NO2. One and a half hours after the start of surgery, we administered droperidol of 1.0 mg IV as prophylaxis for postoperative nausea and vomiting. Within a few minutes, the patient developed ventricular fibrillation (Fig. 1) with a torsade de pointes pattern, which subsided after electrical cardioversion at 200 J. Subsequent monitoring showed ST segment depression. Twelve-lead electrocardiogram approximately 5 min after defibrillation showed slight ST segment elevation in the inferior limb leads, and increased QTc of 463 ms. The ST segment elevation returned to baseline in several minutes. His electrolytes were normal: sodium 142 mEq/L, potassium 3.7 mEq/L, and calcium 7.8 mg/dL. The surgery was completed without complication, using IV lidocaine hydrochloride.Figure 1.: Ventricular fibrillation suddenly occurred a few minutes after an IV injection of 1.0 mg droperidol.On postoperative day 5 the patient underwent cardiac catheterization. Coronary angiograms showed no significant stenosis, but intracoronary injection of 10 μg ergonovine maleate provoked total obstruction of the middle right coronary artery segment (Fig. 2), accompanied by inferior ST segment elevations and polymorphic premature ventricular contractions.Figure 2.: Angiograms showed no significant stenosis in the native coronary arteries. The intracoronary injection of ergonovine maleate provoked occlusive spasm in the right coronary artery (allow).Torsade de pointes was temporally associated with droperidol, but was it caused by droperidol? Myocardial ischemia due to coronary artery spasm likely played a role in inducing ventricular fibrillation (2). Droperidol has been reported to enhance the effect of dopamine by blocking γ-aminobutyric acid receptors on the postsynaptic membrane (3). Dopamine may provoke coronary artery spasm (4), as does ergonovine maleate. Crea et al. (4) administered dopamine to 18 patients with active vasospastic angina. Half of the subjects developed angina and ischemic electrocardiographic changes suggestive of coronary spasm. Thus, one mechanism might be droperidol enhancement of coronary artery spasm. QT prolongation has been considered to be a risk factor for the development of the life-threatening ventricular arrhythmias (5), especially in the case of droperidol administration (1). Our patient showed a mild QT prolongation before surgery and after defibrillation. QTc was not measured strictly immediately after droperidol administration. Lischke et al. (6) studied serial electrocardiograms after injection of droperidol, demonstrating dose-dependent increase in QTc intervals. In isolated guinea pig ventricular myocytes, droperidol lengthened cardiac repolarization by blocking the rapid component of the delayed rectifier potassium current (7). In rabbit Purkinje fibers, droperidol induced early depolarizations and triggered activity (8). Thus, the heart may have been rendered more susceptible to arrhythmia from the coronary spasm, and thus more prone to droperidol-induced torsade. There are two mechanisms that potentially link the administration of droperidol to the onset of ventricular fibrillation with a torsade de pointes pattern. However, we cannot know whether the temporal association was causal or just coincidental. Nobuyuki Miyai, MD Tatsuya Kawasaki, MD, PhD Hiroki Sugihara, MD, PhD Department of Cardiology Ryotaro Kayo, MD Department of Anesthesiology Matsushita Memorial Hospital Osaka, Japan [email protected]

Refractory case of coronary artery spasm with interesting findings: A case report

Refractory case of coronary artery spasm with interesting findings: A case report

A Case of Coronary Artery Spasm Possibly due to Inadequate Anesthesia as Indicated by Bispectral Index

A Case of Coronary Artery Spasm Possibly due to Inadequate Anesthesia as Indicated by Bispectral Index