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Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm
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[Non invasive methylergometrine test should be carried out after cardiac arrest due to coronary spasm?]

D Guindolet1, F Monsel, J-B Estève

  • 1Fédération de cardiologie, centre hospitalier intercommunal, rue du Général-Leclerc, 93370 Montfermeil, France.

Annales De Cardiologie Et D'Angeiologie
|September 21, 2010
PubMed

Insights

Coronary spasm can cause cardiac arrest, even without artery blockages. A methylergometrine test, used to diagnose spasm, can be risky, leading to cardiac arrest and heart block.

Area of Science:

  • Cardiology
  • Clinical Medicine

Background:

  • Coronary artery spasm is a reversible narrowing of the coronary arteries not caused by atherosclerosis.
  • It can lead to serious cardiac events, including myocardial infarction and sudden cardiac death.

Observation:

  • A 59-year-old male presented with cardiac arrest and successful reanimation, with no significant coronary lesions found.
  • He experienced chest pain with ST-segment elevation, responsive to nitrates, leading to a diagnosis of coronary spasm.
  • A subsequent non-invasive methylergometrine test resulted in cardiac arrest due to complete heart block and asystole.

Findings:

  • The patient's cardiac arrest was successfully treated with chest compressions, molsidomine, and epinephrine.
  • No further cardiac events occurred in the six months following the test.
  • The case highlights the potential risks associated with provocative testing for coronary spasm.

Implications:

  • Current international guidelines require further clarification regarding the appropriate use and methodology of the methylergometrine test for monitoring severe coronary spasm.
  • Risk-benefit assessment is crucial when considering provocative testing in patients with a history of severe coronary spasm.
  • Further research is needed to establish standardized protocols for the diagnosis and follow-up of coronary artery spasm.

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