Life-Threatening Coronary Vasospasm Treated by Implantable Cardioverter Defibrillator: The Warning Signs

Abstract

Coronary artery vasospasm is the sudden narrowing of an artery caused by rapid prolonged contraction. It reduces blood supply to the heart and can present with typical cardiac chest pain symptoms. Vasospasm can lead to fatal arrhythmic complications such as ventricular fibrillation. Our case report describes an example of this occurring in a 53-year-old female, and the management plan that ensued. We look at the importance of accurate and prompt diagnosis of vasospasm and how this can have implications for treatment options. One of the available treatments for vasospasm is placement of an implantable cardioverter defibrillator (ICD). This delivers a shock in the event of future life-threatening arrhythmia, with the aim of preventing cardiac arrest. ICD placement, however, is not always a suitable option. This case report discusses the various challenges that arose while making the decision for ICD placement and gives insight into the best available treatment options for coronary artery vasospasm. We also highlight early warning signs that predict life-threatening vasospastic events and how this can be diagnosed and treated appropriately.

Figure 1

‘Abnormal ECG.' This figure is a 12-lead ECG which was taken after resuscitation from cardiac arrest. It shows ST elevation at the J point in leads II, III, and aVF.

Figure 2

‘Right coronary artery: before and after.' This figure is a coronary angiogram containing 2 images (a, b). (a) Narrowing of the right coronary artery shortly after cardiac arrest. (b) How the narrowing of the same right coronary artery was almost completely restored immediately after administration of 400 micrograms of intracoronary nitrate.

Figure 3

‘Normalized ECG.' This figure is a 12-lead ECG which was taken the day after cardiac arrest. It shows a return to normal sinus rhythm and resolution of the inferior ST-segment elevation.