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Case Reports
. 2013 Jun 6:2013:bcr2013010210.
doi: 10.1136/bcr-2013-010210.

Syncope caused by coronary artery spasm without chest pain leading to ventricular fibrillation

Yusuke Kawasaki  1 , Takao Kato, Eri Minamino, Moriaki Inoko
Affiliations
Case Reports

Syncope caused by coronary artery spasm without chest pain leading to ventricular fibrillation

Yusuke Kawasaki et al. BMJ Case Rep. .

Abstract

We present a case of syncope caused by coronary artery spasm without chest pain leading to ventricular fibrillation despite of vasodilator therapy with a calcium channel blocker (CCB). A 68-year-old man presented with two episodes of syncope without chest pain. Ergonovine provocation test induced a diffuse spasm in the right coronary artery (RCA) and subsequently, ventricular fibrillation. Under the therapy with multiple vasodilators including two CCBs, a second ergonovine provocation induced a spasm of the proximal RCA resulting in complete obstruction. Owing to drug-resistant coronary spasm complicated by ventricular fibrillation, an implantable cardioverter defibrillator (ICD) was implanted. This case report highlights the occurrence of syncope caused by coronary artery spasm without chest pain that was refractory to single CCB therapy and needed ICD implantation. Therapy with multiple vasodilators, including two or more CCBs, along with ICD implantation may be required to treat such refractory coronary artery spasms leading to lethal arrhythmia.

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Figures

Figure 1
Figure 1
(A) ECG at baseline. (B) Coronary angiography  at baseline. (C) A diffuse spasm in the right coronary artery by the intracoronary infusion of ergonovine. (D) ECG at 8 min after infusion. A marked elevation was observed in the ST segments in the II, III and aVf leads despite the continuing absence of chest symptoms. (E) Atrioventricular block and ventricular fibrillation was induced with loss of consciousness.
Figure 2
Figure 2
(A) Coronary angiography (CAG) under medication of two CCBs. (B) ECG on a second ergonovine provocation test to the right coronary artery under medication of two CCBs. (C) Complete obstruction in the right coronary artery  was induced.
See this image and copyright information in PMC

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