Vasospasm in smooth coronary arteries as a cause of asystole and syncope

Unverdorben, Martin; Haag, M; Fuerste, Thomas; Weber, H.; Vallbracht, C.

doi:10.1002/(sici)1097-0304(199708)41:4<430::aid-ccd21>3.0.co;2-o

Cited by 14 publications

(4 citation statements)

References 29 publications

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“…Various critical cardiac events, such as acute myocardial infarction and severe cardiac arrhythmias including AV block and ventricular tachyarrhythmias [1][2][3], are associated with attacks of VAP, hence risk stratification and prevention of VAP appear to be crucially important. Coronary spasm plays an essential role in the development of VAP, of which the precise pathogenesis has not been satisfactorily elucidated; however, endothelial dysfunction, especially decreased nitric oxide (NO) bioavailability in coronary endothelial cells, is thought to be involved in the mechanisms [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Impact of high-density lipoprotein cholesterol level in patients with variant angina pectoris

Sugano

Anzai

Yagi

et al. 2010

International Journal of Cardiology

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Section: Introductionmentioning

confidence: 99%

Impact of high-density lipoprotein cholesterol level in patients with variant angina pectoris

Sugano

Anzai

Yagi

et al. 2010

International Journal of Cardiology

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“…Second, the subject patient may be a case of microvascular angina accompanied by coronary artery spasm despite the absence of documented intracoronary ergonovine or acetylcholine‐provoked coronary spasm. Several investigations exist that relate to the exercise‐related atrioventricular block with evidence of vasospasm or transient ischaemia of the conduction system (17–21). Usually, the vasospasm can be demonstrated by ergonovine provocation test (22,23) and treated by nitrate and/or calcium channel blockage for vasodilation, as in the present case.…”

Section: Discussionmentioning

confidence: 99%

Exercise-induced myocardial ischaemia complicated by paroxysmal complete atrioventricular block

Chu

et al. 2004

International Journal of Clinical Practice

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This study describes a case of exercise-induced myocardial ischaemia accompanied by complete atrioventricular block (CAVB). A 59-year-old man with major depression, treated with regular imipramine and lithium for 20 years, experienced syncope episodes during exercise. Exercise, testing initially, identified ST depression in the inferior leads, and later found CAVB resulting in syncope and seizure. The patient recovered completely after resuscitation. Myocardial ischaemic markers were negative, but 35% stenosis was detected in the distal left main coronary artery by angiography. The combined use of verapamil, nitrate and aspirin was treated as the possible coronary spasm. Repeat treadmill caused negative ischaemic study or exercise-induced arrhythmia, 7 days later. The pathophysiology of the very rare exercise-induced paroxysmal CAVB has been reviewed.Exercise-induced complete atrioventricular block (CAVB) in patients with normal resting electrocardiogram is rare (1-4). This study reports the clinical features of a 59-year-old male with recurrent syncope on exercise, caused by CAVB without conduction system abnormalities at rest. To our knowledge, this study is the first to describe a case of exercise-induced myocardial ischaemia resulting in paroxysmal CAVB as the initial presentation in a 59-year-old male. C A S E R E P O R TA 59-year-old male presented to our out-patient department, complaining of syncope that lasted for 5 min after exercise in the morning, on June 17, 2003. The man regularly took imipramine (112 mg per day) and lithium carbonate (600 mg per night) for major depression. Clinical examination was unremarkable. Resting ECG revealed sinus rhythm. The patient underwent a treadmill test immediately after presenting at our clinic. After 3 min of performing the stage 1 exercise test, the patient complained of chest discomfort with ST elevation in the inferior leads and V2 (Figure 1). The patient then suddenly collapsed and suffered a CAVBinduced seizure (Figure 2A). Subsequently taken ECG displayed persistently elevated ST in the inferior leads and V1 with reciprocal ST depression in V2 to V6 ( Figure 2B). Following 4-min emergent resuscitation, the patient recovered completely except for persisting sinus tachycardia (Figure 3). Sequential cardiac troponin-I and creatine kinase MB were normal. Other test results included elevated uric acid (12.4 mg/dl, normal range: 2.5-7.5 mg/dl) and cholesterol (219 mg/dl, normal limit: below 200 mg/dl). Blood levels of imipramine and lithium carbonate were both within normal limits. Chest X-ray, echocardiography and brain computer tomograph were all unremarkable. 1 h later, emergent coronary angiography indicated 35% stenosis in the distal left main coronary artery with TIMI 4 flow, and no obvious thrombus was demonstrated. However, the patient refused to perform ergonovine provocation for coronary artery or electrophysiological studies. Under the impression of coronary spasm, the patient was treated daily with aspirin (100 mg), verapamil SR (240 mg), isosorbide-5-m...

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“…Izražen i prolongiran vazospazam sa produženim prekidom protoka u koronarnoj arteriji može dovesti do pojave nekroze miokarda sa porastom aktivnosti kardiospecifičnih enzima u serumu i do razvoja non Q ili Q-infarkta miokarda [4][5][6][7] . Može doći i do pojave tranzitornog Q-zupca u elektrokardiogramu, što je posledica prolaznog gubitika električne aktivnosti membrane miokardnih ćelija u toku spazma.…”

Section: Diskusijaunclassified

“…Epizode koronarnog spazma mogu biti praćene poremećajima srčanog ritma i provođenja, može doći i do pojave sinkopa, čak i nagle srčane smrti 5,6 . Pojava transmuralne ishemije miokarda uzrokovane spazmom koronarne arterije može dovesti do poremećaja srčanog ritma koji se mogu ispoljiti simultano sa nastankom ishemije, a mogu se pojaviti i kasnije, u toku reperfuzije, sa popuštanjem koronarnog spazma 7 .…”

Section: Diskusijaunclassified

Vasospastic angina pectoris complicated by acute myocardial infarction and complete atrioventricular block

et al. 2011

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Vasospasm in smooth coronary arteries as a cause of asystole and syncope

Cited by 14 publications

References 29 publications

Impact of high-density lipoprotein cholesterol level in patients with variant angina pectoris

Impact of high-density lipoprotein cholesterol level in patients with variant angina pectoris

Exercise-induced myocardial ischaemia complicated by paroxysmal complete atrioventricular block

Vasospastic angina pectoris complicated by acute myocardial infarction and complete atrioventricular block

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