Sudden cardiac death and coronary spasm: a case report

Area of Science:

• Cardiology
• Electrophysiology
• Vascular Medicine

Background:

• Sudden cardiac death (SCD) remains a significant clinical challenge, often with unclear underlying causes.
• Standard diagnostic evaluations for ventricular arrhythmias may not identify all mechanisms of SCD.
• Coronary artery spasm is a recognized but sometimes overlooked cause of cardiac events.

Observation:

• A 55-year-old male presented with documented ventricular fibrillation (VF).
• Extensive invasive and non-invasive testing, including electrophysiology study, coronary angiography, and electrocardiogram (ECG) analysis, revealed no inducible ventricular arrhythmia or obstructive coronary disease.
• Normal ejection fraction and nuclear treadmill test results further complicated the diagnostic picture.

Findings:

• During an in-hospital event mimicking prior symptoms, anterior ST segment elevations were observed, responding promptly to sublingual nitroglycerin.
• This observation strongly suggested transient coronary artery spasm as the likely cause of the initial event.
• An implantable cardioverter-defibrillator (ICD) was placed prophylactically.

Implications:

• Unexplained cases of sudden death or ventricular fibrillation may be attributable to occult coronary artery spasm.
• A combination of pharmacologic therapy (calcium channel blockers and nitroglycerin) and device therapy (ICD) may be a viable strategy for managing patients with suspected coronary spasm-induced arrhythmias.
• This case highlights the importance of considering coronary vasospasm in the differential diagnosis of unexplained cardiac arrest.