Coronary vasospasm as an etiology of recurrent ventricular fibrillation in the absence of coronary artery disease: a case report

Abstract

Background: Vasospastic angina (VA), or Prinzmetal's angina, is characterized by symptoms of coronary angina caused by coronary vasospasm, usually in the absence of atherosclerotic changes. It typically presents with chest pain, which can be accompanied by transient electrocardiographic changes, if visualized during the attack. It can also rarely present with severe manifestations of acute myocardial angina, ventricular fibrillation, or cardiac arrest. Case presentation: We present a case of a 50-year-old Caucasian male who initially presented to the hospital with chest pain and was diagnosed with VA. Later, he was brought to the hospital by emergency medical services later with ventricular fibrillation, despite normal coronary anatomy on angiogram. He was managed with placement of an intra-cardiac defibrillator (ICD) for secondary prevention. The patient continued to have recurrent episodes of ventricular fibrillation with associated ICD shocks, and had multiple admissions to the hospital with similar presentations. Symptoms and arrhythmia improved after optimizing antianginal therapy. Conclusions: Ventricular fibrillation can be an uncommon but severe manifestation during VA crises. In cases with normal coronary vasculature, it is important to recognize VA as a cause of recurrent ventricular fibrillation in order to optimize medical management for prevention of fatal arrhythmias.

Unleashing an Underlying Serious Cardiac Arrhythmia: A Case of Coronary Vasospasm With Atypical Presentation

“…Pathogenetic mechanisms, including endothelial dysfunction, primary smooth muscle cell hyper-reactivity, abnormal growth factor production, and adventitial abnormalities, contribute to CAS [ 5 ]. It predominantly affects younger female individuals without traditional cardiovascular risk factors, besides cigarette smoking, but can also lead to severe manifestations, such as acute myocardial angina, ventricular fibrillation, or cardiac arrest [ 6 ]. Ventricular arrhythmias, notably ventricular fibrillation and ventricular tachycardia, are common during vasospastic angina crises [ 6 ].…”

“…It predominantly affects younger female individuals without traditional cardiovascular risk factors, besides cigarette smoking, but can also lead to severe manifestations, such as acute myocardial angina, ventricular fibrillation, or cardiac arrest [ 6 ]. Ventricular arrhythmias, notably ventricular fibrillation and ventricular tachycardia, are common during vasospastic angina crises [ 6 ]. The arrhythmic risk of coronary vasospasm ranges from 2% to 17%, varying based on baseline-risk profiles [ 7 ].…”

“…The arrhythmic risk of coronary vasospasm ranges from 2% to 17%, varying based on baseline-risk profiles [ 7 ]. CAS can lead to life-threatening ventricular arrhythmias, as illustrated by case reports of recurrent ventricular fibrillation and polymorphic ventricular tachycardia associated with CAS [ 6 , 7 ]. Medical management involves calcium channel blockers as the cornerstone therapy, with long-acting nitrates or other medications added as second-line treatments if angina symptoms persist [ 7 , 8 ].…”

Adherence to the Mediterranean Diet Association with Serum Levels of Nitric Oxide, Prostacyclin, and Thromboxane B2 among Prinzmetal Angina Patients and Healthy Persons

“…Acetylcholine stimulates the endothelium to produce nitric oxide [ 41 ]. Endothelial damage leads to a lack of proper endothelial response to acetylcholine to produce Nitric oxide [ 42 ].…”