Sudden cardiac death and coronary spasm: a case report

A case involving a 55-year-old man with documented ventricular fibrillation is presented. Invasive evaluation revealed no inducible ventricular arrhythmia, and nonobstructive coronary disease. Ejection fraction and results of nuclear treadmill test and signal-averaged electrocardiogram were normal. An automatic cardiodefibrillator was implanted. In-hospital symptoms that replicated symptoms preceding sudden death revealed anterior ST segment elevations, which were treated with sublingual nitroglycerin. Follow-up after 27 months of calcium blocker and nitroglycerin therapy was uneventful and without device activity. Patients with unexplained sudden death may have unsuspected coronary spasm as the primary substrate. Combination drug and device therapy may be appropriate in such patients.