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Vasospasm in smooth coronary arteries as a cause of asystole and syncope
M Unverdorben1, M Haag, T Fuerste
1Center for Cardiovascular Diseases, Rotenburg/Fulda, Germany.
Catheterization and Cardiovascular Diagnosis
|August 1, 1997
Insights
Prinzmetal
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Myocardial infarction (MI) diagnosis.
- Angiographically confirmed absence of coronary artery disease (CAD).
- Recurrent syncope of unknown etiology.
Observation:
- Holter monitoring revealed ST-segment elevation.
- Documented progression from first-degree AV block to asystole.
- Syncope episodes correlated with documented electrophysiological abnormalities.
Findings:
- Prinzmetal's angina identified as the cause of syncope.
- Successful management with gallopamil and a VVI-pacemaker.
- Complete resolution of syncopal episodes and symptoms.
Implications:
- Suggests Prinzmetal's angina as a rare cause of syncope.
- Highlights the importance of considering vasospastic angina in unexplained syncope.
- Demonstrates effective therapeutic strategies for this condition.
Abstract:
In a patient with proven myocardial infarction, coronary artery disease was excluded angiographically. Four weeks later the patient experienced recurrent syncope of unknown cause. By means of Holter monitoring, ST-segment elevation with subsequent first-degree AV block progressing to asystole and resulting in loss of consciousness were documented. Treatment with gallopamil and a VVI-pacemaker led to complete relief of all symptoms. Hence, Prinzmetal's angina may be a rare cause of syncope even in smooth coronary arteries.