[A Rare Cause of Acute Coronary Occlusion with Inferior ST-Elevation Myocardial Infarction and Out of Hospital
Tomislav Miljak1, Kristina Lohrengel1, Wolfgang Rupp1
1Klinik für Innere Medizin II (Kardiologie), Klinikum Sindelfingen-Böblingen.
Insights
A patient experiencing cardiac arrest due to ventricular fibrillation was revived. Prompt nitroglycerin administration during angiography led to complete reperfusion, preventing the need for stenting and ensuring a good recovery.
Area of Science:
- Cardiology
- Emergency Medicine
- Interventional Cardiology
Background:
- Out-of-hospital cardiac arrest (OOHCA) due to ventricular fibrillation requires immediate intervention.
- Electrocardiogram (ECG) findings post-resuscitation can indicate underlying coronary artery issues.
- Elevated ST-segments in inferior leads suggest acute myocardial injury.
Observation:
- A 59-year-old female presented with OOHCA and ventricular fibrillation.
- Post-resuscitation ECG revealed ST-segment elevation in inferior leads.
- Coronary angiography showed complete right coronary artery occlusion.
Findings:
- Intracoronary nitroglycerin administration resulted in rapid and complete reperfusion.
- No persistent stenosis was noted after nitroglycerin treatment.
- Stenting was successfully avoided due to successful pharmacologic intervention.
Implications:
- Routine intracoronary nitroglycerin administration prior to percutaneous coronary intervention (PCI) is recommended for acute coronary syndromes.
- Patients resuscitated from cardiac arrhythmias caused by coronary spasm benefit from implantable cardioverter-defibrillator (ICD) placement due to high recurrence risk.
- This case highlights the efficacy of nitroglycerin in managing acute coronary occlusions and preventing invasive procedures.
History:
The 59-year old female was successfully resuscitated after out of hospital cardiac arrest due to ventricular fibrillation. The ECG after return of spontaneous circulation showed elevated ST-segments in the inferior leads.
Findings And Diagnosis:
Acute coronary angiography confirmed a complete occlusion of the right coronary artery without collateral flow. However, a few seconds after intracoronary administration of nitroglycerin complete reperfusion was achieved without persistent relevant stenosis.
Therapy And Course:
Stenting of the vessel was withheld. After controlled hypothermia and 68 h on respirator therapy the patient was extubated and showed no persistent neurological disorders. On day 6 she received an implantable cardioverter-defibrillator. Two weeks after the index event the patient could be discharged in good condition. Routine intracoronary administration of nitroglycerin before balloon dilatation or stenting is therefore highly recommended, also in the setting of acute coronary syndromes. Because of the high risk of recurrence, patients resuscitated from lethal cardiac arrhythmia, caused by coronary spasm should receive a cardioverter-defibrillator.
Related Concept Videos
00:59Hospitals-II
Nurses that work in...
01:30Acute Coronary Syndrome I: Introduction
01:28Hospitals-I
01:26Acute Coronary Syndrome V: Nursing Management
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies