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[Coronary artery spasm as a rare cause of sudden heart arrest]
A Schuchert1, K H Kuck, W Bleifeld
1Abteilung für Kardiologie, Universitäts-Krankenhaus Eppendorf, Hamburg.
Insights
This case study highlights a rare cause of cardiac arrest: coronary artery vasospasm. A woman experienced recurrent cardiac arrest linked to epigastric pain, successfully treated with calcium antagonists.
Area of Science:
- Cardiology
- Clinical Medicine
Background:
- Cardiac arrest survivors often have identifiable causes.
- Some patients present with normal findings post-resuscitation, posing diagnostic challenges.
Observation:
- A 39-year-old woman experienced three cardiac arrests within 10 months, each preceded by epigastric pain.
- Electrocardiogram (ECG) during an episode showed ST-segment elevation and ventricular tachycardia.
- Coronary angiography revealed ergonovine-induced right coronary artery spasm and occlusion.
Findings:
- The patient's cardiac arrests were attributed to coronary artery vasospasm, not organic heart disease.
- ST-segment elevation on ECG correlated with coronary artery spasm.
- Treatment with a calcium antagonist prevented further vasospastic episodes and cardiac arrests.
Implications:
- This case highlights coronary artery vasospasm as a potential cause of recurrent cardiac arrest.
- Epigastric pain can be an atypical symptom of coronary vasospasm.
- Early diagnosis and appropriate medical management can effectively treat vasospastic angina and prevent life-threatening events.
Abstract:
After successful resuscitation only few patients present without any findings indicative of the causes of their cardiac arrest. We report on a 39-year-old woman who had normal clinical, electrocardiographic, and angiographic findings after she was successfully resuscitated. In contrast to other patients without apparent organic heart disease she had three cardiac arrests within 10 months; each episode was preceded by an ascending epigastric pain. During an attack with epigastric pain a long-term ECG recording documented an increasing ST-segment elevation followed by rapid, non-sustained ventricular tachycardia. Intravenous ergonovine induced a spasm of the right coronary artery with a subtotal vessel occlusion and an ST-elevation in lead III. After medication with a calcium antagonist no coronary vasospasm was demonstrated. For 11 months the patient has been without any complaints.