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Ventricular fibrillation induced by coronary spasm during noncardiac surgery
International Journal of Cardiology
|September 29, 1999
Insights
Ventricular fibrillation during noncardiac surgery may stem from coronary artery spasm, even without significant coronary artery disease. Acetylcholine-induced spasm in two patients suggests this potential link.
Area of Science:
- Cardiology
- Anesthesiology
- Cardiac Electrophysiology
Background:
- Ventricular fibrillation (VF) is a critical cardiac emergency.
- Noncardiac surgery presents unique anesthetic challenges.
- Coronary artery disease (CAD) is a known risk factor for cardiac events during surgery.
Observation:
- Two patients experienced ventricular fibrillation during noncardiac surgical procedures.
- Emergency coronary angiograms revealed no significant coronary artery stenosis in either patient.
- Intracoronary acetylcholine injection successfully induced coronary artery spasm.
Findings:
- Coronary artery spasm was identified as a potential trigger for ventricular fibrillation.
- The findings suggest a possible mechanism for VF in patients without apparent coronary artery disease.
- Acetylcholine-induced spasm highlights the role of vasoreactivity in perioperative cardiac events.
Implications:
- This study suggests considering coronary artery spasm in the differential diagnosis of VF during noncardiac surgery.
- Anesthesiologists and cardiologists should be aware of this potential complication.
- Further research is warranted to elucidate the prevalence and management of coronary artery spasm-induced VF in surgical settings.
Abstract:
We report two cases of ventricular fibrillation during noncardiac surgery. Although an emergency coronary angiogram showed no significant coronary stenosis, coronary artery spasm was induced by the intracoronary injection of acetylcholine. It is possible that ventricular fibrillation is caused by coronary artery spasm during noncardiac surgery in patients without overt coronary artery disease.