Sudden cardiac death from coronary artery spasm in a healthy subject

Abstract

The true incidence of sudden cardiac death (SCD) from coronary artery spasm is unknown. The following case involves SCD in a previously asymptomatic young man with reasonable evidence to implicate coronary artery spasm as a potential cause for his clinical event. Ergonovine provocation may be warranted in patients who present with SCD and no discernable cause.

Ergonovine-Testing-Directed Therapy and Long-Term Outcome of Sudden-Death Survivors withNo Apparent Heart Disease

“…This account adds to data supporting the use of ergonovine testing in these patients and brings the number of reported patients with coronary-artery-vasospasm-induced sudden cardiac death to 17, of which 16 have been treated with calcium channel blockers without a reported event [1][2][3]. This is significant as untreated survivors of coronary-artery-vasospasm-induced sudden cardiac arrest have a 6-month sudden-death rate of 18% [4].…”

“…Based on these data, we recommend ergonovine testing on all patients with sudden cardiac death and no structural heart disease and advocate using calcium blockers as treatment. Some propose that the dose used be determined by suppression of ergonovine-induced vasospasm [1][2][3]. However, the largest study with the longest followup treated patients empirically with the maximally tolerated dose of these agents [2].…”

“…A ventriculogram showed hypokinesis of the anterior wall and a normal ejection fraction. Ergonovine testing by standard protocol induced severe chest pain and ST elevation at 0.2 mg intravenously [3]. Occlusion of the LAD at the site of narrowing was documented and relieved by 400 Ìg of intracoronary nitroglycerine ( fig.…”

“…However, in the subset of survivors without identifiable heart disease, coronary vasospasm, spontaneous or ergonovine induced, is the presumptive cause in 38-64% [1,2]. Two studies and 1 case report totalling 15 patients (9 Japanese and 6 US) have reported on this subset and show that calcium entry blockers are the proper treatment for these patients [1][2][3]. In this report, we describe the 6th and 7th US patients with ergonovine-induced vasospasm as the identifiable cause of sudden death successfully treated with calcium channel blockers.…”