Initiation of beta-blockers can provoke severe multi-vessel coronary spasm leading to lethal ventricular arrhythmias, highlighting the need to consider coronary spasm in cardiac arrest survivors without structural heart disease.
Supports caution with beta-blocker initiation in unexplained VF; hypothesis-generating for spasm testing in cardiac arrest survivors without structural disease.
We describe a case of ventricular fibrillation occurring in a patient with multi-vessel coronary spasm after the initiation of an oral beta-blocker. A 56-year-old man began to experience chest discomfort and his computed tomography revealed intermediate coronary stenoses. He was administered medications including an oral beta-blocker but suddenly collapsed while walking 4 days later. An automated external defibrillator detected ventricular fibrillation and delivered successful electrical cardioversion. An acetylcholine provocation test after stabilization of the status revealed triple-vessel coronary spasm. Beta-blockers may provoke exacerbation of coronary spasm and result in lethal arrhythmia. LEARNING POINTS: Beta-blockers which have a vasoconstrictive effect may occasionally provoke exacerbation of coronary spasm.Coronary spasm should be considered as a cause of lethal ventricular arrhythmia or cardiac arrest.
No takes yet. Share an insight, caveat, or question.
Kurabayashi et al. (2016) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: