Prinzmetal’s Variant Angina During Extradural Anaesthesia

Abstract

A 55-yr-old male undergoing varicose vein surgery with an extradural block complained of chest pain. E.c.g. changes and subsequent examination of the heart including coronary angiography suggested the diagnosis of Prinzmetal's variant angina. The therapeutic implications of this condition in patients undergoing anaesthesia and surgery are discussed.

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

“…Vasospasm during regional anesthesia [2][3][4][28][29][30][31] has been described in a few case reports and may be related to epinephrine use [2], inadequate analgesia level [3], and even hypercalcemia or sympathetic blockers [4]. It is impossible to establish from the case reports any statistical relationship connected with general anesthesia [5,21,24,33,[43][44][45].…”

“…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].…”

Recurrent ST-segment elevations in a patient without significant coronary disease

“…Excessive a-adrenergic or vagal activity has been thought to play an important role in the pathogenesis of coronary artery spasm [3,4,7,9,18]. The first episode of our case occurred after epidural administration.…”

“…Various contributing factors to coronary artery spasm during noncardiac surgery have been suggested, such as a-adrenergic stimulation [4,5], b-adrenergic blockade [6], increased vagal activity [7,8], reflective cardiac sympathetic activity [9], altered sympathovagal balance [3], aspiration of the tracheobronchial tree and/or inadequate depth of anesthesia [2], and endotracheal intubation [10]. The probable factors contributing to the first episode of coronary artery spasm in this particular case include cold stimulus, epidural anesthesia, and inadequate depth of anesthesia.…”

Atropine injection followed by coronary artery spasm with ventricular tachycardia during spinal anesthesia -A case report-

“…Above the level of the sympathetic blockade, compensatory vasoconstriction is observed, presumably in an effort to offset the reduction in the peripheral resistance caused by the block. This sympathetic activity reflex involves the cardiac sympathetic nerves causing coronary vasoconstriction and the consequent ischemia [8]. It is likely, in this current case, that a combination of an activated sympathetic nervous system by atropine and spinal anesthesia may be responsible for the coronary artery spasm.…”