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Difficult management of a patient presenting with recurrent syncope caused by diffuse vasospasm
Abdulkadir Uslu1, Serdar Demir1, Munevver Sari1
1Department of Cardiology, Health Sciences University, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey.
Northern Clinics of Istanbul
|January 29, 2019
Summary
Spontaneous multivessel coronary artery spasm can cause serious heart issues. Dual implantable cardioverter defibrillators (ICDs) offer a treatment option for life-threatening arrhythmias resistant to medical therapy.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Spontaneous and simultaneous multivessel coronary artery spasm is a rare condition.
- It can manifest with diverse and severe cardiac complications including myocardial ischemia, atrioventricular block, and ventricular arrhythmias.
Observation:
- A 57-year-old male presented with syncope, chest pain, bradycardia, and diffuse coronary artery spasm.
- The patient experienced life-threatening ventricular arrhythmias during ischemic episodes.
Findings:
- The underlying mechanism of vasospasm-induced syncope can be complex, involving atrioventricular block and/or ventricular arrhythmias.
- Dual implantable cardioverter defibrillator (ICD) placement was performed due to refractory ventricular arrhythmias.
Implications:
- Dual ICD implantation should be considered in patients with multivessel coronary artery spasm and life-threatening ventricular arrhythmias.
- This approach may be crucial when medical management is insufficient to control diffuse spasms and associated arrhythmias.
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