Recurrent intraoperative coronary artery spasm in a patient with coronary artery aneurysm

Area of Science:

• Cardiology
• Anesthesiology
• Vascular Medicine

Background:

• Coronary artery spasm (CAS) is a reversible narrowing of the coronary arteries, often linked to endothelial dysfunction.
• CAS can occur in arteries without significant obstructive lesions, presenting diagnostic challenges.
• Complications of CAS include myocardial infarction, arrhythmias, and sudden cardiac death.

Observation:

• The case report details a patient experiencing intraoperative CAS during two separate surgical procedures.
• Initial angiography revealed nonobstructed coronary arteries, complicating the diagnosis of ischemia.
• Recurrent ST elevations during the second surgery were rapidly resolved with nitroglycerin administration.

Findings:

• Intraoperative CAS can present similarly to obstructive coronary ischemia, making diagnosis difficult under general anesthesia.
• Prompt recognition and treatment of CAS with vasodilators like nitroglycerin can effectively manage acute episodes.
• A high index of suspicion is vital for diagnosing CAS in the perioperative setting.

Implications:

• This case highlights the importance of considering non-obstructive causes of intraoperative ischemia.
• Early diagnosis and management of CAS can prevent severe cardiac events and improve surgical outcomes.
• Further research into the mechanisms and anesthetic management of CAS is warranted.