A Rare Case of Cardiogenic Shock following Severe Multivessel Coronary Vasospasm

  • Reza Rahmani Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
  • Amirfarhangh Zand Parsa Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
  • Alborz Sherafati Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
  • Roozbeh Kowsari Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
  • Vahid Mohammadi Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
  • Rizan Mohammadi Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Keywords: Angina pectoris, variant, Coronary vasospasm, Shock, cardiogenic

Abstract

Prinzmetal’s angina occurs following spasms in a single or multiple vascular beds, resulting in a typical chest pain and an ST-segment elevation in electrocardiography (ECG). It can lead to life-threatening arrhythmias and sudden cardiac death. We describe a 37-year-old woman who was admitted with a typical chest pain and hypotension. Her initial ECG showed an ST-segment elevation in the inferior and precordial leads. She was transferred to the catheterization unit, where coronary angiography illustrated multivessel spasms. The spasms were relieved with a nitroglycerin injection. She was discharged with stable hemodynamics 7 days later, and at 1 month’s follow-up, no recurrent attack was detected.

References

1. Sugiishi M, Takatsu F. Cigarette smoking is a major risk factor for coronary spasm. Circulation 1993;87:76-79.
2. Yasue H, Nakagawa H, Itoh T, Harada E, Mizuno Y. Coronary artery spasm--clinical features, diagnosis, pathogenesis, and treatment. J Cardiol 2008;51:2-17.
3. Menichetti F, Orsini E, Delle Donne MG, Dini FL, Marzilli M. ST-segment elevation acute myocardial infarction associated with hyperthyroidism: beware of coronary spasm! J Cardiovasc Med (Hagerstown) 2017;18:798-799.
4. Parikh A, Vacek TP. Spontaneous left main and right coronary artery spasm in a patient with vasospastic angina. J Investig Med High Impact Case Rep 2017;5:2324709617732796.
5. Sueda S, Kohno H, Fukuda H, Ochi N, Kawada H, Hayashi Y, Uraoka T. Clinical impact of selective spasm provocation tests: comparisons between acetylcholine and ergonovine in 1508 examinations. Coron Artery Dis 2004;15:491-497.
6. Matsue Y, Suzuki M, Nishizaki M, Hojo R, Hashimoto Y, Sakurada H. Clinical implications of an implantable cardioverter-defibrillator in patients with vasospastic angina and lethal ventricular arrhythmia. J Am Coll Cardiol 2012;60:908-913.
7. Bory M, Pierron F, Panagides D, Bonnet JL, Yvorra S, Desfossez L. Coronary artery spasm in patients with normal or near normal coronary arteries. Long-term follow-up of 277 patients. Eur Heart J 1996;17:1015-1021.
8. Ahn JM, Lee KH, Yoo SY, Cho YR, Suh J, Shin ES, Lee JH, Shin DI, Kim SH, Baek SH, Seung KB, Nam CW, Jin ES, Lee SW, Oh JH, Jang JH, Park HW, Yoon NS, Cho JG, Lee CH, Park DW, Kang SJ, Lee SW, Kim J, Kim YH, Nam KB, Lee CW, Choi KJ, Song JK, Kim YH, Park SW, Park SJ. Prognosis of variant angina manifesting as aborted sudden cardiac death. J Am Coll Cardiol 2016;68:137-145.
9. Gül I, Aykan AC, Gökdeniz T, Celik S. A new hope in the treatment of coronary vasospasm: Bosentan. Turk Kardiyol Dern Ars 2013;41:633-637.
10. Kim NH, Ko JS. Can documented coronary vasospasm be the smoking gun in settling the etiology of sudden cardiac death? Korean J Intern Med 2017;32:816-818.
11. Gaspardone A, Tomai F, Versaci F, Ghini AS, Polisca P, Crea F, Chiariello L, Gioffrè PA. Coronary artery stent placement in patients with variant angina refractory to medical treatment. Am J Cardiol 1999;84:96-98, A8.
12. Ong P, Athanasiadis A, Borgulya G, Voehringer M, Sechtem U. 3-year follow-up of patients with coronary artery spasm as cause of acute coronary syndrome: the CASPAR (coronary artery spasm in patients with acute coronary syndrome) study follow-up. J Am Coll Cardiol 2011;57:147-152.
Published
2019-01-16
How to Cite
1.
Rahmani R, Zand Parsa A, Sherafati A, Kowsari R, Mohammadi V, Mohammadi R. A Rare Case of Cardiogenic Shock following Severe Multivessel Coronary Vasospasm. J Tehran Heart Cent. 14(1):28-2.
Section
Case Report(s)