Ewha Med J.  2014 Mar;37(1):56-59. 10.12771/emj.2014.37.1.56.

Coronary Spastic Angina and Life Threatening Arrhythmia despite Nitroglycerine Infusion

• Shin KH
• Cho WH
• Lee DH
• Lee S
• Lim SH

• KMID: 2171276
• DOI: http://doi.org/10.12771/emj.2014.37.1.56

Abstract

Variant angina pectoris is characterized by chest symptoms at rest and transient ST elevation on the electrocardiography due to coronary artery spasm. Although most patients with coronary spasm respond well to medical treatment with vasodilators such as calcium channel blockers and nitrates, some patients show intractable attack of coronary vasospasm despite standard medical therapy. We experienced 50-year-old woman with intractable chest pain due to coronary artery spasm, who suffered from ventricular fibrillation despite continuous intravenous nitrate therapy.

Keyword

Coronary vasospasm; Cardiac arrhythmia; Variant angina pectoris

MeSH Terms

Angina Pectoris, Variant
Arrhythmias, Cardiac*
Calcium Channel Blockers
Chest Pain
Coronary Vasospasm
Coronary Vessels
Electrocardiography
Female
Humans
Middle Aged
Muscle Spasticity*
Nitrates
Nitroglycerin*
Spasm
Thorax
Vasodilator Agents
Ventricular Fibrillation
Calcium Channel Blockers
Nitrates
Nitroglycerin
Vasodilator Agents

Figure

• 

  Fig. 1 Electrocardiogram (ECG) on admission. (A) ECG shows ST segment elevation in inferior leads (II, III, aVF). (B) The ECG shows complete remission of ST segment elevation after intravenous nitroglycerin.

• 

  Fig. 2 ECG after intravenous infusion of nitrates. It shows ventricular fibrillation which is developed despite the intravenous infusion of nitrates.

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  Fig. 3 Coronary angiogram. (A) Coronary angiogram reveals a severe spasm in the proximal and distal portion of right coronary artery. (B) The proximal and distal spasms of the right coronary artery are improved by repeated intracoronary injection of nitroglycerine.

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