Key result
Vasodilators and an ICD successfully treat coronary vasospasm-induced ventricular fibrillation arrest.
Case Report (n=1)
Coronary artery spasm is a rare but important cause of out-of-hospital cardiac arrest that may be missed by initial angiography if the spasm has resolved, highlighting the value of symptom-guided repeat assessment.
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Hypothesis-generating for coronary spasm in unexplained VF arrest; leaves open whether provocative testing or specific therapies improve outcomes.
We present a case of ventricular fibrillation (VF) secondary to ischaemia induced by coronary artery spasm. An 82-year-old man initially presented with an out-of-hospital VF arrest. On return of spontaneous circulation (ROSC), he was found to be in fast atrial fibrillation (AF); an invasive coronary angiogram revealed unobstructed coronary arteries. During his hospital stay, he developed chest pain, with concomitant ST elevation on ECG (electrocardiogram), which spontaneously resolved. A repeat coronary angiography revealed coronary spasm. Later, he had further ST elevation resulting in ventricular fibrillation. It became clear his initial presentation was most likely due to coronary vasospasm rather than a plaque-rupture or ventricular scar-related event, and he was thus successfully treated with multiple vasodilators and an implantable cardiac defibrillator. This case report highlights how conventional imaging modalities may not always lead to a diagnosis.
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Rathod et al. (2020) conducted a case report in Out-of-Hospital Cardiac Arrest due to Coronary Spasm (n=1). Vasodilators (diltiazem and bisoprolol) and implantable cardiac defibrillator (ICD) was evaluated on Clinical outcome and recurrence of ventricular fibrillation. In an 82-year-old man, an out-of-hospital ventricular fibrillation arrest was identified as being caused by coronary vasospasm and successfully treated with vasodilators and an implantable cardiac defibrillator.
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