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Multivessel Coronary Artery Spasm

Mohammad Ahmed1, Muhammad Soofi1, Maulin Patel1

  • 1Penn State Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.

JACC. Case Reports
|May 9, 2025
PubMed

Insights

Coronary artery spasm (CAS) can cause recurrent cardiac arrest. A left stellate ganglion block effectively treated a severe multivessel CAS case refractory to medical therapy.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Neurology

Background:

  • Coronary artery spasm (CAS) involves reversible narrowing of coronary arteries due to smooth muscle hypercontractility.
  • Recurrent cardiac arrest is a critical condition often requiring advanced interventions.

Observation:

  • A 47-year-old woman with a history of cardiac arrests presented after experiencing multiple life-threatening events.
  • She required defibrillator shocks and extracorporeal membrane oxygenation due to hemodynamic instability.
  • Coronary angiography revealed severe multivessel CAS, which responded to intracoronary nitroglycerin.

Findings:

  • The patient's severe multivessel CAS was successfully treated with intracoronary nitroglycerin.
  • A left stellate ganglion block was performed, leading to the patient's recovery and decannulation.
  • She was discharged on oral vasodilators for management of recurrent CAS.

Implications:

  • Multivessel coronary artery spasm leading to cardiac arrest is a rare but serious clinical presentation.
  • Left stellate ganglion block offers a potential therapeutic option for refractory CAS.
  • This case highlights the importance of considering CAS in patients with recurrent unexplained cardiac arrest.

Keywords:
Prinzmetal anginacardiac arrestcoronary artery spasmcoronary vasospasm

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