Successful Use of Levosimendan in Managing Refractory Coronary Vasospasm Leading to Recurrent Cardiac Arrests: A Case Report

Abstract

Background Coronary vasospasm can be life threatening and can be refractory. First line therapies include calcium channel blockers and nitrates; however, they have variable effectiveness. This case report presents a case of refractory coronary artery vasospasm presenting with ST elevation and recurrent cardiac arrest who was treated with levosimendan, a distinctive inodilator with calcium-sensitising and ATP-sensitive potassium channel opening properties, highlighting its potential therapeutic role in this clinical setting. Case Presentation: A 57-year-old male with an established diagnosis of coronary vasospasm presenting with ST elevation in the inferior leads and suffered multiple cardiac arrests, initially treated with electrical defibrillation and advanced life support measures. Angiography showed mild coronary artery disease unchanged from previous angiograms. The patient was managed in the Intensive Care Unit (ICU) with Glyceryl trinitrate (GTN) infusion but continued to have episodes of inferior ST elevations on electrocardiogram (ECG). Given the refractory vasospasm, levosimendan infusion was initiated at 0.2 mcg/kg/min for 24 hours, leading to stabilization with no further episodes and was eventually discharged from hospital. Conclusions Levosimendan, with its unique pharmacological profile as a calcium sensitizer and potassium channel opener, offers a promising therapeutic option for managing refractory coronary vasospasm. Its dual action improves cardiac contractility and induces significant vasodilation, addressing the underlying pathophysiology of vasospasm. The presented case highlights the potential of levosimendan in stabilizing patients with refractory coronary vasospasm when conventional therapies fail. Further research and clinical trials are warranted to establish its efficacy and safety profile in a broader patient population.