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Coronary artery spasm complicated by atrial septal puncture: A case report
Ping Gong1, Yong Da Zhang, Yuan Zhi Zhou
1Mianyang 404 Hospital, Mianyang, China.
Insights
Severe coronary artery spasm during atrial septal puncture can cause ST-segment elevation on ECG in atrial fibrillation patients. Prompt intervention with percutaneous coronary intervention and stenting is crucial for managing this rare complication.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- ST-segment elevation on electrocardiogram (ECG) during transseptal puncture for atrial fibrillation is uncommon.
- The exact cause of this ECG change remains unclear.
Purpose of the Study:
- To identify the cause of ST-segment elevation during transseptal puncture.
- To report a case of severe coronary artery spasm as a cause of ST-segment elevation.
Main Methods:
- A 66-year-old woman with atrial fibrillation underwent transseptal puncture.
- She developed ST-segment elevation and hypotension post-procedure.
- Coronary angiography revealed right coronary artery occlusion and spasm, treated with percutaneous coronary intervention and stenting.
Main Results:
- The patient experienced ST-segment elevation and hemodynamic instability after atrial septal puncture.
- Percutaneous coronary intervention successfully treated the coronary artery spasm and stenosis.
- The patient recovered and was discharged after 12 days.
Conclusions:
- Severe coronary artery spasm can cause ST-segment elevation during atrial septal puncture.
- Concurrent coronary artery stenosis may lead to persistent vasospasm and severe complications.
- Preoperative coronary angiography or CTA is recommended to identify patients at risk.
Rationale:
The occurrence of ST-segment elevation on electrocardiogram (ECG) during transseptal puncture in atrial fibrillation procedures is relatively uncommon, and its pathogenesis remains unclear. In this report, we clearly identified severe coronary artery spasm during atrial septal puncture as one of the causes of ECG ST-segment elevation.
Patient Concerns:
A 66-year-old woman was admitted to the hospital due to "paroxysmal palpitations for 1 year, with worsening symptoms for 1 week." Both the admission ECG and previous ECGs diagnosed her with atrial fibrillation. Immediately after routine atrial septal puncture, she experienced a drop in blood pressure and abnormal ECG changes, leading to serious complications.
Diagnoses:
Persistent atrial fibrillation.
Interventions:
Femoral artery puncture for coronary angiography indicated occlusion of the proximal right coronary artery. Percutaneous coronary intervention of the right coronary artery was immediately performed. During the operation, it was confirmed that there was combined spasm on the basis of coronary artery stenosis. Nitroglycerin and sodium nitroprusside were repeatedly intravenously injected, norepinephrine was intravenously infused, an intra-aortic balloon pump and a temporary pacemaker were implanted. Subsequently, a 4.0 × 18 mm coronary stent was implanted.
Outcomes:
The patient's symptoms improved, with resolution of ST-segment elevation on the ECG, and blood pressure and heart rate increased. Ultimately, the patient was discharged after 12 days of hospitalization with improvement.
Lessons:
Coronary artery spasm after atrial septal puncture is rare, and most cases are transient and do not lead to serious complications. However, if the patient has concurrent fixed stenosis, it may cause persistent vasospasm, resulting in severe complications. Preoperative coronary angiography or coronary CTA is a necessary examination.
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