Coronary artery spasm induced by anesthesia: A case report and review of the literature

Abstract

Summary: Anesthesia-induced coronary vasospasm has been reported only rarely. We report a case, without previous cardiac history, in which immediately after anesthesia induction a marked ST elevation was noted on the EKG monitor. Premature ventricular contractions as well as nonsustained ventricular tachycardia were noted. These changes resolved immediately after nitroglycerin infusion and 75 mg of lidocaine were given. A coronary angiogram revealed normal comnary arteries and left ventriculogram. Eeonovine stimulation was not performed. The patient was discharged home on calcium entry blockers and nitrates. Exercise stress test two weeks after discharge was negative for ischemia. Induction of anesthesia triggering coronary spasm has been reported rarely, and to our knowledge never in the presence of angiographically normal coronary anatomy. Coronary vasospasm with typical EKG changes-namely, ST elevation and ventricular arrhythmias-has to be included as a possible complication of general anesthesia. Recognition of this syndrome allows prompt treatment and prevention of future episodes.

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.…”

“…There are few cases of this variant angina during surgery and anesthesia reported in patients with normal coronary anatomy [23,24]. There are also few reports of coronary vasospasm during regional anesthesia and neuroaxial block [28][29][30][31].…”

“…Coronary artery spasm rarely has been reported during regional [2][3][4] or general anesthesia [5][6][7] and has been implicated even more rarely as a cause of sudden, unexpected circulatory collapse and death during surgery and anesthesia [5,[8][9][10][11][12][13][14][15][16][17][18][19][20] in patients undergoing coronary artery bypass grafting procedures [16,18,19] and other noncardiac surgical procedures [7,21,22]. There are few cases of this variant angina reported during surgery and anesthesia in patients with normal coronary anatomy [23,24]. To our knowledge, induction of anesthesia has been implicated only once in a patient with normal coronary arteries [24].…”

Angiographic documentation of coronary artery spasm induced by anesthesia

“…When stenosis is seen with ergonovine or acetylcholine induction, the right coronary artery is usually involved [5]. Coronary spasm may be related to excess alpha adrenergic activity, stimulation of the parasympathetic nervous system, altered humoral factors, increases in blood pH, and imbalance of vasoconstrictor-vasodilator forces [6].…”