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Ventricular fibrillation related to coronary spasm in patients without significant coronary or other structural heart
S Behrens1, D Andresen, T Brüggemann
1Abteilung für Innere Medizin mit Schwerpunkt Kardiologie und Pulmologie, Klinikum Steglitz, Freie Universität Berlin, Germany.
Insights
Coronary artery spasm can cause ventricular fibrillation in patients without structural heart disease. Early diagnosis and treatment, including defibrillator implantation in select cases, are crucial for managing this condition.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Ventricular fibrillation (VF) is a life-threatening arrhythmia.
- Coronary artery spasm is a potential, though less common, cause of cardiac events.
- Identifying non-structural causes of VF is critical for appropriate management.
Abstract:
We present three patients without significant coronary or other structural heart disease who were resuscitated after ventricular fibrillation attributed to coronary spasm. Angina pectoris was present in two of the cases and silent myocardial ischemia in the third. All patients were given calcium antagonists at discharge. A defibrillator was also implanted in the patient with silent myocardial ischemia because further episodes of ischemia would probably have occurred without premonitory symptoms. Coronary spasm might be a mechanism of ventricular fibrillation in patients without significant structural heart disease. Diagnostic tests should therefore be performed to confirm or exclude coronary spasm in such cases. The implantation of an automatic defibrillator seems justified in selected patients with documented coronary spasm, silent myocardial ischemia, and associated sustained ventricular tachyarrhythmia, although prospective studies are not yet available.