An Unusual Case of Vasospastic Angina Resulting in Multiple Episodes of Cardiac Arrest

Figures

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  Figure 1. Coronary angiography after first cardiac arrest episode. (A) Left coronary artery. Blue arrow shows the LAD segment with 50% stenosis, TIMI coronary flow grade 3, and the red arrow shows the distal LAD with 90% stenosis segment, stent inserted, TIMI 3; (B) Right coronary artery. Yellow arrow shows 1-30% stenosis, TIMI 3. All stenosis had little or no calcium. LAD: left anterior descending; TIMI: thrombolysis in myocardial Infarction

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  Figure 2. ECG sequence during the second episode of chest pain and cardiac arrest. (A) ECG taken at the beginning of chest pain and patient was noted to be in atrial fibrillation. There is also T wave inversion in V2-V6 and leads I and aVL and ST depression V4-V6 suggesting ischemia in the LCA territory; (B) ECG recorded five minutes after the first, showing non-sustained monomorphic ventricular tachycardia (three complexes V1-V3), ST segment elevation in leads I and aVL; (C) ECG taken 10 minutes after the second, showing complete AV node block, ST segment elevation in inferior leads with reciprocal changes in lateral and anterior leads suggesting ischemia in the RCA territory. A few seconds after this ECG was recorded, the patient went into cardiac arrest in PEA. AV: atrioventricular; RCA: right coronary artery; PEA: pulseless electric activity