[Intraoperative coronary spasm during caesarean section under spinal anesthesia]

Area of Science:

• Cardiology
• Anesthesiology
• Obstetrics

Background:

• A 37-year-old woman without cardiac history underwent cesarean section under spinal anesthesia.
• Initial hypotension (93/72 mmHg) was treated with ephedrine, leading to further BP drop (75/40 mmHg) and nausea.

Observation:

• Administration of ephedrine, phenylephrine, and atropine increased BP to 170/100 mmHg.
• Electrocardiogram (ECG) revealed ST elevation and premature ventricular beats, with patient reporting chest discomfort.
• Treatment with coronary dilators and lidocaine resolved ECG changes and symptoms.

Findings:

• The cardiac event was likely coronary artery spasm induced by acute sympathetic stimulation.
• Despite recurrent hypotension during surgery, vasopressors were withheld to prevent recurrent ischemia.

Implications:

• Intraoperative coronary spasm is a possibility even in patients without known cardiac risk factors.
• Anesthesiologists and obstetricians should consider coronary spasm in the differential diagnosis of intraoperative cardiac events.
• This case underscores the importance of recognizing and managing acute coronary events during cesarean delivery.