Cardiac arrest and repeated ST-segment elevation caused by initially unrecognized coronary vasospasm

Abstract

Introduction Coronary artery spasm (CAS) is defined as a transient vasoconstriction of an epicardial coronary artery with a total or subtotal vessel occlusion, causing myocardial ischemia. Although the overall incidence of CAS during coronary angiography is estimated to be between 0.3% and 1%, CAS remains an underdiagnosed and undertreated cause of acute cardiac events.

Case outline We report a case of a 62-year-old male presenting with cardiac arrest and repeated ST-segment elevations during chest pain episodes, caused by initially unrecognized CAS. Although percutaneous coronary intervention (PCI) is generally not recommended for the treatment of CAS, due to clinical manifestations and the presence of underlying flow-limiting stenosis, we decided to perform PCI of the left anterior descending coronary artery. During the two-year-follow up period, the patient reported no chest pains nor exercise limitations at regular outpatient controls.

Conclusion CASs should be considered an unrecognized cause of refractory angina, acute coronary syndrome, malignant arrhythmia, and even cardiac arrest. Although medical therapy is the first option for CAS treatment, PCI could be a safe and effective approach in selected patients.

Keywords: coronary vasospasm; fractional flow reserve; myocardial infarction; optical coherence tomography; percutaneous coronary intervention