Recurrent cardiac arrest and complete atrioventricular block due to idiopathic coronary vasospasm: A case report

Figures

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  Fig. 1. The patient's ECG changes during two episodes of illness. First episode: (A) Complete atrioventricular block and inferior ST-segment elevation (STE) at home (heart rate 45 bpm); (B) Sinus rhythm recovery after cardiopulmonary resuscitation (CPR), heart rate 73 bpm (precordial leads 1.25 mm/mV). Second episode: (C) Junctional escape rhythm at home (heart rate 32 bpm); (D) Junctional rhythm and inferior STE at the emergency department (heart rate 50 bpm) (precordial leads 5 mm/mV); (E) Sinus rhythm recovery after CPR, heart rate 73 bpm.

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  Fig. 2. Coronary angiography with different projection angles revealed normal left (A–D) and right coronary arteries(E-F).

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  Fig. 3. The patient had another life-threatening arrhythmia due to coronary spasm on day seven. (A) ECG (lead II) before cardiopulmonary resuscitation (CPR): (i) Sinus rhythm, 90 bpm (8:23 a.m.); (ii) Sinus rhythm with broad R waves (lambda wave), 94 bpm (8:24 a.m.); (iii) Sinus rhythm with broader and notched R waves, 94 bpm (8:25 a.m.); (iv) High-grade atrioventricular block (AVB), 68 bpm (8:26 a.m.); (v) Complete AVB, 34 bpm, no blood pressure (8:26 a.m., 33 seconds after iv-chart). Chest compression, adrenaline and atropine given. (B) ECG after CPR: (i) Lambda waves still present after 30 minutes of compression, with ST-segment elevation resembling nonischemic “action potential” or unusual “tombstone” (8:54 a.m.); (ii) Ventricular fibrillation (8:54 a.m.); (iii) Complete AVB after 150 J defibrillation (8:54 a.m.); (iv) First-degree AVB with atrial ectopy (8:55 a.m.); (v) Sinus tachycardia, 140 bpm (8:57 a.m.).

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  Fig. 4. Timeline of the case. CAS coronary artery spasm, CAVB complete atrioventricular block, CCU coronary care unit, CPR cardiopulmonary resuscitation, CRRT continuous renal replacement therapy, ICD Implantable cardioverter defibrillator.