Coronary Artery Spasm Discovered in Thorough Examination of Perioperative VT in a 26-year-old Japanese Male.

Abstract

SUMMARYWe thoroughly examined a 26-year-old Japanese male who experienced perioperative ventricular tachycardia. After inhaling sevoflurane, his nasal cavity was soaked with 1:100,000 epinephrine and he was intubated through the nose. Junctional tachycardia occurred five minutes after intubation, changing to ventricular tachycardia. Six-time cardioversion was required to stop the ventricular tachycardia. Echocardiography immediately following the event showed diffuse hypokinesis, and an electrocardiogram showed an inversion of T waves in II, III, a V F and V 4-6 . Both returned to normal within a few days. Tl scintigraphy revealed a normal perfusion image. Coronary angiography showed a normal coronary, but an injection of acetylcholine induced vasospasm in the right coronary artery. Examination of left ventricular tissue yielded no specific findings. During electrophysiological tests, ventricular tachycardia could not be induced even in the presence of isoprenaline. This is a very young case to elicit vasospasm in the coronary artery with no underlying heart disease. Although the relationship between perioperative ventricular tachycardia and coronary spasm is unknown, cardiac events can occur during anesthesia in young and low-risk patients. (Jpn Heart J 2003; 44: 1021-1026 Key words: Perioperative ventricular tachycardia, Epinephrine, Spasm CASE REPORTA 26-year-old Japanese male (height: 174 cm; weight: 68 kg; smoking history; 8 years) was admitted to our hospital for surgery on a superior conchal cyst. Blood pressure was 120/64 mmHg and heart rate was 51 bpm and regular; there was no audible heart murmur. His preoperative chest X-ray and electrocardiogram showed no abnormalities. Hematological tests and urinalysis were within normal limits except for mild liver damage. The day of the operation, after inhalation of sevoflurane, his nasal cavity was soaked with 1: 100,000 epinephrine From

Coronary vasospasm during anesthesia induction: awareness, recognition, possible mechanisms, anesthetic factors, and treatment

“…There are also few reports of coronary vasospasm during regional anesthesia and neuroaxial block [28][29][30][31]. Some of the case reports appear in the Japanese medical literature [22,32], and many are reported by Japanese physicians in the western medical literature [4,23,24,28,29,32,33]. It is unclear if the incidence or prevalence of this variant angina is higher in the Japanese population, or if there is just more awareness and reporting.…”

“…It is impossible to establish from the case reports any statistical relationship connected with general anesthesia [5,21,24,33,[43][44][45]. A higher number of cases are found or reported among Japanese patients [4,5,[22][23][24]28,29,32,33,43]; however, further study is necessary to establish a genetic or environmental component to this rare phenomenon.…”

Acute myocardial infarction after administration of low-dose intravenous epinephrine for anaphylaxis

“…However, the majority were from overdoses or operating room use. 6,7 We searched PubMed for articles in the past 25 years, using various combinations of the search words (e.g., epinephrine, adrenaline, acute myocardial infarction, ischemia, anaphylaxis). We were only able to identify 3 cases of myocardial infarction associated when therapeutic doses of epinephrine were used for the treatment of anaphylaxis: 2 after SC injection and 1 after self-administration of epinephrine by way of an EpiPen ™ .…”

Wandering coronary stenoses: Adrenaline‐induced coronary artery spasm in a patient resuscitated from cardiac arrest

“…Adrenaline‐induced coronary artery spasm has been recorded in several case reports, with subsequent occurrence of chest pain, arrhythmia, up to myocardial infarction. Yet, most cases were described in association with high dose administration or in the setting of intraoperative use [1, 2]. However, the tremendous occurrence of adrenaline‐induced myocardial infarction after the administration of therapeutic doses of adrenaline for the management of anaphylaxis/hypersensitivity reactions has been repetitively mentioned in literature [3–6].…”