[Diagnosis and treatment of spastic angina revealed by cardiac arrest]

Area of Science:

• Cardiology
• Clinical Medicine

Background:

• Vasospastic angina (VSA) prevalence in Europe is potentially underestimated due to diagnostic challenges in routine practice.
• Coronary artery spasm is a significant cause of cardiac arrest, particularly in individuals without pre-existing heart disease.
• Systematic investigation for coronary spasm is recommended following unexplained cardiac arrest.

Observation:

• Intracoronary spasm provocation tests offer a lower risk profile compared to spontaneous vasospastic angina events.
• Accurate diagnostic modalities and criteria for vasospastic angina require further clarification for the European population.
• External triggers like smoking and certain drugs can induce coronary spasm, necessitating avoidance.

Findings:

• Treatment for VSA primarily involves avoiding triggers and administering antispastic medications, notably calcium channel blockers.
• Recurrent coronary spasms can occur despite optimal treatment, sometimes necessitating interventions like implantable automatic defibrillators after cardiac arrest.
• A case is presented of a patient with cardiac arrest, positive spasm provocation, treated with calcium channel blockers and an defibrillator, with subsequent provocative testing yielding contentious results.

Implications:

• This case highlights the importance of considering coronary spasm in unexplained cardiac arrest and the complexities in its diagnosis and management.
• Further research is needed to refine diagnostic criteria and treatment strategies for vasospastic angina in the European context.
• The findings underscore the potential for recurrent spasms and the need for individualized treatment plans, including advanced device therapy.