Cardiopulmonary arrest due to persistent coronary spasm in a young woman

Wakabayashi, Kohei; Suzuki, Hiroshi; Shinmura, Kazuki; Yamaya, Sayaka; Maezawa, Hideyuki; Honda, Yuki; Wakatsuki, Daisuke; Shimizu, Nobuyuki; Asano, Fuyuki; Sato, Tokutada; Takeyama, Youichi

doi:10.1016/j.ijcard.2009.02.044

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…19,20) It is not rare that a first time attack causes a critical situation in the emergency room. To prevent sudden cardiac death, an early diagnosis, early medical intervention, and early prevention of a VSA attack are needed.…”

Section: Discussionmentioning

confidence: 99%

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Malondialdehyde-Modified Low Density Lipoprotein as Oxidative-Stress Marker in Vasospastic Angina Patients

et al. 2017

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SummaryVasospastic angina (VSA) is caused by endothelial dysfunction and hypercontraction of vascular smooth muscle cells. Although oxidative-stress can induce endothelial dysfunction, the relationship of VSA and the oxidative-stress marker malondialdehyde-modified low density lipoprotein (MDA-LDL) remains unclear. Purpose: Serum MDA-LDL was evaluated in candidate VSA patients.The subjects were 84 patients admitted to our hospital because of chest pain at rest. We stratified the patients into 3 groups; definite VSA, suspected VSA, and unlikely VSA according to a Japanese Circulation Society (JCS) guideline. The patients classified as definite VSA or suspected VSA were considered as "clinical VSA".Forty cases were classified as definite VSA, 35 as suspected VSA, and 9 as unlikely VSA. Thus, clinical VSA was the diagnosis in 75 cases. The patient characteristics showed that the average age of the patients was 60.2 years old (men, 61%). The serum MDA-LDL level of the clinical VSA group (126.3 ± 38.0 U/L) was significantly higher than the unlikely VSA group (98.7 ± 31.1 U/L). Serum MDA-LDL was positively correlated with total cholesterol (T-Chol), lowdensity lipoprotein cholesterol (LDL-C), triglycerides, and fasting blood glucose. Multivariate analysis showed that serum MDA-LDL was the most predictive marker for making a diagnosis of clinical VSA (Odds ratio 1.064, 95% confidence interval 1.014-1.145, P = 0.008). In a population with positive or borderline ECG change, the positive rate in the acetylcholine provocation test was significantly higher in the MDA-LDL higher group compared to the MDA-LDL lower group (81% versus 37%, P = 0.032).: Serum MDA-LDL might be a useful biomarker of VSA and have additional value for the diagnosis of clinical VSA. (Int Heart J 2017; 58: 335-343)

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Section: Discussionmentioning

confidence: 99%

“…Recently, statins such as fluvastatin have been reported to be effective in the management of VSA. 18) Some VSA patients have a poor prognosis due to sudden death, acute myocardial infarction (AMI), or ventricular fibrillation (VF) 19,20) if they do not receive proper medical treatment.…”

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confidence: 99%

Malondialdehyde-Modified Low Density Lipoprotein as Oxidative-Stress Marker in Vasospastic Angina Patients

et al. 2017

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“…3 Yet it is a phenomenon that is infrequently reported, and as described by this case report, is a diagnosis that is settled upon when all else has been excluded. 1 It is appreciated that coronary vasospam is an underdiagnosed entity, and new attention is being paid to the subtleties of this condition and its early recognition and ECG 3 management. Patients who are at risk are not the typical overweight, middle-aged men who suffer from coronary artery stenosis, but rather younger patients, particularly of Eastern Asian origin, who are smokers.…”

Section: Discussionmentioning

confidence: 99%

“…Intracoronary injection of acetylcholine induces a short-lived vasospasm that is visible on imaging in the affected artery or arteries. 1,3 The degree of constriction may also be visualised. The invasive nature of the required test and expertise render it an on-table investigation that is far from ideal, but is currently the gold standard diagnostic tool.…”

Section: Discussionmentioning

confidence: 99%

“…Various precipitants experienced during the induction of anaesthesia may have triggered the vasospasm, namely the hypotension induced by the propofol induction, a Bezoldt-Jarisch reflex secondary to the positioning, the use of ephedrine, the adrenaline bolus, histamine release induced by the fentanyl, or even a brief period of hyperventilation. 1 A nicotine withdrawal may also have contributed. 2 …”

Section: Differential Diagnosismentioning

confidence: 99%

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An unusual case of ST elevation

Gordon

Wise

2013

Southern African Journal of Anaesthesia and Analgesia

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Prompt institution of percutaneous cardiopulmonary support managed perioperative refractory vascular spasm after isolated coronary artery bypass grafting surgery

Nakazawa

Moriyama

Motoyasu

et al. 2013

Gen Thorac Cardiovasc Surg

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A 51-year-old Japanese male underwent on-pump coronary artery bypass grafting surgery. After weaning from cardiopulmonary bypass (348 min), sudden bradycardia and hypotension occurred, followed by ventricular fibrillation. Although defibrillation and infusion of catecholamine restored sinus rhythm, transesophageal echocardiography demonstrated severely reduced contraction of both ventricles, and perioperative vascular spasm was suspected. As vascular spasm was refractory to medications, percutaneous cardiopulmonary support (PCPS) system was quickly instituted under cardiac massage. Coronary angiography revealed vascular spasm of not only the native coronary arteries but also the implanted left internal thoracic artery. After 3 days of full hemodynamic assist, PCPS was withdrawn with no obvious abnormalities in regional wall motion by transesophageal echocardiography. The patient was extubated on postoperative day 6 with no impaired brain function. In this case, the immediate diagnosis of refractory vascular spasm by transesophageal echocardiography and full cardiocirculatory assistance by PCPS helped to save the life of the patient.

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Cardiopulmonary arrest due to persistent coronary spasm in a young woman

Cited by 5 publications

References 7 publications

Malondialdehyde-Modified Low Density Lipoprotein as Oxidative-Stress Marker in Vasospastic Angina Patients

Malondialdehyde-Modified Low Density Lipoprotein as Oxidative-Stress Marker in Vasospastic Angina Patients

An unusual case of ST elevation

Prompt institution of percutaneous cardiopulmonary support managed perioperative refractory vascular spasm after isolated coronary artery bypass grafting surgery

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