Coronary artery spasm induced by carotid sinus stimulation during neck surgery

We observed four transient episodes of marked ST-segment elevation in a 58-yr-old man with no history of coronary artery disease undergoing resection of a metastatic neck mass under general anaesthesia. Elevations of the ST segment were abrupt, with no change in arterial pressure or heart rate, and resolved spontaneously. When the carotid sinus was compressed directly, ST-segment elevation was noted 1 min after the onset of stimulation. After surgery, coronary angiography showed diffuse, slight narrowing of the distal bed of the posterolateral branch of the right coronary artery. Ergonovine caused total occlusion of the posterolateral branch of the right coronary artery with chest pain and ST-segment elevation, confirming the diagnosis of variant angina. The coronary artery spasm seems to have been provoked by vagal activation from carotid sinus stimulation during general anaesthesia.