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Coronary artery spasm with sinus node dysfunction and syncope
Insights
Coronary artery spasm can cause sinus node dysfunction, leading to dizziness and syncope. Severe, widespread coronary spasm, even in healthy arteries, can be fatal, highlighting its significant cardiovascular impact.
Area of Science:
- Cardiology
- Vascular Medicine
- Electrophysiology
Background:
- Spontaneous angina, dizziness, and syncope are concerning symptoms.
- Sinus node dysfunction can manifest with these symptoms.
- Coronary artery spasm is a potential cause of cardiac events.
Observation:
- A 55-year-old male presented with angina, dizziness, and syncope.
- Holter monitoring revealed sinus node dysfunction.
- Coronary angiography demonstrated severe, diffuse coronary artery spasm.
Findings:
- Pacemaker implantation corrected the patient's symptoms.
- The patient experienced fatal pump failure post-catheterization.
- Autopsy showed minimal coronary atherosclerosis, indicating spasm as the primary issue.
Implications:
- Coronary artery spasm can precipitate sinus node dysfunction and syncope.
- Extensive coronary spasm can lead to fatal outcomes.
- Severe coronary spasm can occur independently of significant coronary atherosclerosis.
Abstract:
In a 55-year-old man, attacks of spontaneous angina were associated with dizziness and syncope. Holter ECG monitoring disclosed evidence of sinus node dysfunction. Dizziness and syncope were corrected by a permanent ventricular demand pacemaker. Coronary cineangiography showed spontaneous, severe, diffuse spasm in a dominant left coronary artery and localized spasm in a nondominant right coronary artery. The patient died of pump failure shortly after cardiac catheterization. An autopsy disclosed only minimal coronary atherosclerosis. This patient's condition shows that (1) coronary spasm may cause sinus node dysfunction, dizziness, and syncope, (2) severe spasm that involves all the coronary artery branches may be fatal, and (3) severe spasm occur in minimally diseased coronary arteries confirmed by pathologic examination.