Cardiogenic Shock From Global Myocardial Ischemia Induced by Simultaneous Multivessel Coronary Spasm

Ahn, Ji-Hye; Kim, Bosung; Park, Hyekyong; Park, Kyungil

doi:10.4070/kcj.2012.42.6.427

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…The ECG changes seen in our patient are similar to those of patients with proven multivessel coronary vasospasm. (12,13) In a study of patients with suspected vasospastic angina, diffuse multivessel involvement was described to be present in the majority of patients who demonstrated coronary vasospasm. (14) The involvement of the entire pericardial sac, as evident in this patient, increases the likelihood of multivessel coronary inflammation and, by extension, multivessel vasospasm.…”

Section: U Lt I V E S S E L C O R O N a R Y A R T E R Y S Pa S M I mentioning

confidence: 99%

“…Sequelae of coronary artery spasm can include cardiogenic shock and arrhythmic complications. (13,17) Management includes coronary vasodilators and supportive management for any cardiac complications. To our knowledge, this is the first case report that describes multivessel coronary vasospasm in a patient with pericarditis.…”

Section: U Lt I V E S S E L C O R O N a R Y A R T E R Y S Pa S M I mentioning

confidence: 99%

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Multivessel coronary artery spasm in pericarditis

Lim

Singh

Loh

et al. 2018

smedj

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Dear Sir, Coronary vasospasm can result in tombstone-like ST elevations in the presence of non-obstructive coronary arteries on angiography. Coronary vasospasm has been reported to coexist with myocarditis, possibly due to endothelial dysfunction or coronary smooth muscle cell hyperreactivity. We herein describe a novel presentation of tombstone-like ST elevations that were likely from multivessel coronary vasospasm in a patient with pericarditis. A 40-year-old man with a three-day history of an infected right lower molar tooth presented to the emergency department with dysphagia, shortness of breath and right neck swelling. There was no complaint of chest pain, and he had no past medical history or any cardiac problems prior to presentation. Electrocardiography (ECG) performed at the point of admission showed typical global concave upward ST elevations with PR interval depression consistent with pericarditis (Fig. 1a). Further investigations revealed elevated inflammatory markers. Computed tomography of the neck and thorax, which was performed in view of his presentation history, showed gas gangrene in the neck communicating with the mediastinum, likely due to contiguous infection. The patient underwent surgery for his disease and received broad-spectrum antibiotics, as guided by microbiological cultures. On the sixth day of admission, diffuse tombstone-like non-territorial ST elevations were seen on ECG without any symptom or haemodynamic instability (Fig. 1b); they completely resolved after 15 minutes. There were no Q waves thereafter. The diffuse tombstone-like ST elevations recurred on the tenth day of admission and again resolved after 15 minutes. Peak serum troponin levels were marginally elevated at 0.063 mcg/L (normal < 0.040 mcg/L). The patient was under sedation and intubated for the first two weeks of his admission.

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Section: U Lt I V E S S E L C O R O N a R Y A R T E R Y S Pa S M I mentioning

confidence: 99%

Section: U Lt I V E S S E L C O R O N a R Y A R T E R Y S Pa S M I mentioning

confidence: 99%

Multivessel coronary artery spasm in pericarditis

Lim

Singh

Loh

et al. 2018

smedj

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“…[ 2 ] In most cases, a single epicardial coronary artery is involved; however, coronary artery spasm sometimes occurs in more than one artery and may last longer than in usual angina. [ 3 ] Concurrent total ischemia due to multiple coronary artery spasms with clinical manifestations of cardiogenic shock has rarely been reported. Here, we present a patient with transient cardiogenic shock induced by diffuse multivessel coronary artery spasm (DMV-CAS) during hospitalization.…”

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confidence: 99%

Sudden diffuse spasm of multiple coronary arteries: A case report

Cai,

Chen,

Wang

2024

Medicine

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Rationale: Diffuse multivessel coronary artery spasm (DMV-CAS) was defined as a severe and reversible diffuse spasm occurring in more than 2 major coronary arteries, which is rare in clinical practice. Due to a wide lesion scope, DMV-CAS often occurs in the form of complications. It is not easy to be clinically diagnosed because it is too brief to be caught. Here, we report a rare case of spontaneous subtotal occlusion of 3 major coronary arteries induced by Vasalva action, which was confirmed in real-time by CAG. Patient concerns: A 68-year-old man had sudden chest pain after forced defecation during hospitalization. The electrocardiogram showed transient ST segment elevation of the inferior wall lead, inversion of the anterior wall, and lateral wall leads T waves. Emergency CAG revealed elongated vessel beds in 3 coronary arteries and multiple diffuse stenosis, but none of the coronary arteries were completely occlusive. Diagnoses: Diagnoses of DMV-CAS were made based on CAG findings and postmedication response. Interventions: Nitroglycerin was administered in the coronary arteries. The anti-vasospasm, antiplatelet aggregation and lipid-regulating drugs were administered orally. Outcomes: The patient was discharged on the 7th day with complete resolution of symptoms and normalization of the electrocardiography findings. No ischemic events occurred during a follow-up for 5 months. Lessons: This case highlights the identification of multivessel diffuse coronary spasm and acute myocardial infarction, and the prevention of CAS triggers, which requires the attention of clinicians.

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