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Successful treatment of coronary artery spasm following coronary artery bypass grafting
F Donatelli1, M A Mariani, M Pocar
1Istituto Malattie dell'Apparato Cardiovascolare e Respiratorio, Università degli Studi, IRCCS H San Raffaele, Milano.
Insights
Coronary artery spasm after myocardial revascularization was effectively treated with intravenous nifedipine and glyceronitrate. This combination therapy resolved hemodynamic and electrocardiographic changes, preventing myocardial infarction.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Coronary artery spasm can occur post-myocardial revascularization, leading to hemodynamic and electrocardiographic disturbances.
- Intracoronary isosorbide dinitrate was ineffective in reversing the documented spasm.
Abstract:
A case of coronary artery spasm developed 6 hours after myocardial revascularization inducing both hemodynamic and electrocardiographic changes, is reported. The spasm was documented by coronary angiography, and it was not reversed by intracoronary infusion of isosorbide dinitrate. Intravenous infusion of nifedipine (initial dose of 0.0104 mg/min to final dose of 0.0208 mg/min), along with infusion of glyceronitrate (1.0 micrograms/kg/min) was able to significantly improve hemodynamic impairment and to reverse electrocardiographic changes in 12 hours. Coronary angiography, repeated in postoperative day 3, after 48 hours of continuous nifedipine infusion, showed a resolution of coronary spasm. There was no evidence of myocardial infarction as resulted from total CPK and MB isoenzyme release. Nifedipine infusion was gradually reduced as oral administration of slow release nifedipine (40 mg twice daily) was started. The combined intravenous infusion of glyceronitrate and nifedipine seems to be able to control and overcome coronary artery spasm following coronary surgery.