Clinical Implications of an Implantable Cardioverter-Defibrillator in Patients With Vasospastic Angina and Lethal Ventricular Arrhythmia

Matsue, Yuya; Suzuki, Makoto; Nishizaki, Mitsuhiro; Hojo, Rintaro; Hashimoto, Yuji; Sakurada, Harumizu

doi:10.1016/j.jacc.2012.03.070

Cited by 106 publications

(93 citation statements)

References 21 publications

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“…39 Furthermore, in an observational study of 23 patients who had vasospasm with ventricular arrhythmia, at a median follow-up of 2.1 years, 5 patients had a cardiac arrest (4 with ventricular fibrillation and 1 with pulseless electric activity). 40 Considering the morbidity associated with long-term intracardiac devices, particularly in this patient population, which tends to be younger, alternatives, such as a subcutaneous ICD or wearable cardioverter-defibrillator, may be considered in the future. For example, a recent communication describes the use of a wearable cardioverter-defibrillator in patients with a high risk of sudden cardiac death, including one with coronary artery vasospasm.…”

Section: February 23 2016mentioning

confidence: 99%

A Shocking Development in a Young Male Athlete With Chest Pain

et al. 2016

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Foreword Information about a real patient is presented in stages (boldface type) to an expert clinician (Dr Deepak L. Bhatt), who responds to the information, sharing his reasoning with the reader (regular type). A discussion by the authors follows. P atient presentation:A 32-year-old male endurance athlete with no significant past history was admitted after experiencing multiple episodes of chest tightness while training for a triathlon. Occasionally, when running up hills, he noted substernal chest pressure that radiated to his left arm and was associated with severe shortness of breath. His past medical history includes seasonal allergic rhinitis and childhood asthma. He takes cetirizine/pseudoephedrine occasionally, but has not taken it recently, and denies taking any other medication or over-the-counter supplement. He admits to occasional binge drinking of 6 to 10 beers once or twice a month. He quit smoking 2 years ago but previously smoked a pack a week for 5 years. He also endorsed a remote history of cocaine use and recent marijuana and energy drink (1-2 small cans; 80 mg of caffeine per 8.4-oz can) use. His family history is only notable for a maternal grandmother who had a myocardial infarction in her 60s and a sister diagnosed with an atrial tachycardia. There is no history of premature coronary artery disease, heart failure, or sudden death. His biological parents and brother are alive and well.Dr Bhatt: At this point, the differential diagnosis for chest pain in a young, otherwise healthy patient is broad. Certainly, the exertional component of his symptoms is concerning and raises the possibility of premature coronary artery disease, although the family history obtained does not suggest a strong predisposition for atherosclerosis. Coronary artery vasospasm would be another possibility, and he has several potential triggers, including alcohol, pseudoephedrine, caffeine, and marijuana use. Vasospasm can occur with exertion, even though we often think of it as occurring at rest. Forms of structural heart disease, such as hypertrophic or infiltrative cardiomyopathy or an anomalous coronary artery, should be entertained. I would also consider an arrhythmia, either supraventricular or ventricular. The appropriate next steps are a targeted physical examination, an ECG, and a transthoracic echocardiogram to evaluate for structural heart disease. Patient presentation (continued):His vital signs were as follows: temperature, 96.0°F; blood pressure, 136/88 mm Hg; heart rate, 56 beats per minute and regular; respiratory rate, 14 breaths per minute; and oxygen saturation, 98% on room air. He was well appearing. His jugular venous pressure was 6 cm H 2 O. His lungs were clear to auscultation bilaterally. His cardiac examination revealed normal S1 and S2 heart sounds, no murmurs or gallops, no heaves, and a nondisplaced apical impulse. His extremities were warm and without edema. Serial troponin-T concentrations were undetectable. An ECG showed normal sinus rhythm with normal intervals and no evidence of hypertr...

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Section: February 23 2016mentioning

confidence: 99%

A Shocking Development in a Young Male Athlete With Chest Pain

et al. 2016

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“…The nationwide multicenter study conducted by the Japanese Coronary Spasm Association found that VSA patients who survived OHCA are particularly a high-risk population, even in the current era with long-acting calcium channel blockades (Takagi et al 2011). Although a recent study with a small number of patients reported that ICD therapy combined with medication is appropriate for this high-risk VSA population (Matsue et al 2012), further studies are needed to determine whether ICD therapy improves the long-term prognosis of VSA patients who survived OHCA.…”

Section: Sudden Cardiac Death In Variant Anginamentioning

confidence: 99%