Anesth Pain Med.  2017 Apr;12(2):155-158. 10.17085/apm.2017.12.2.155.

Resuscitated cardiac arrest caused by coronary artery spasm after coronary artery bypass grafting: A case report-

• Park J
• Park J
• Lee SM

• KMID: 2379737
• DOI: http://doi.org/10.17085/apm.2017.12.2.155

Abstract

We report successful resuscitation of a patient after cardiac arrest on postoperative day 4 after coronary artery bypass grafting (CABG). The patient underwent proximal right coronary artery stent insertion 1 year preceding his CABG, and in-stent restenosis of the stent was found on coronary angiography (CAG). CABG was planned. The patient was treated with a nitroglycerin (NTG) for chest pain, and in the holding area of the operating theater, his chest pain resumed during brief cessation of the NTG while changing the syringe pump. Intraoperatively, normal flow was confirmed at the graft site with flowmetry, while the patient received a NTG infusion. On postoperative day 4, the patient developed chest pain and a subsequent cardiac arrest. He was resuscitated with chest compressions alone, and emergent CAG was performed. It showed coronary artery spasm of the left anterior descending coronary artery, confirmed by provocation testing. The patient was discharged with symptoms well controlled on oral medications.

Keyword

Cardiac arrest; Coronary artery bypass grafting; Coronary artery spasm; Nitroglycerin; Percutaneous coronary intervention

MeSH Terms

Chest Pain
Coronary Angiography
Coronary Artery Bypass*
Coronary Vessels*
Heart Arrest*
Humans
Nitroglycerin
Percutaneous Coronary Intervention
Resuscitation
Rheology
Spasm*
Stents
Syringes
Thorax
Transplants
Nitroglycerin

Figure

• 

  Fig. 1 Coronary angiography at another institution revealed in-stent restenosis of the previous right coronary artery (RCA) stent (blank arrow).

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  Fig. 2 Postoperative emergent coronary angiography showed diffuse luminal irregularity of the left anterior descending artery (black arrow) and a patent right coronary artery graft (blank arrow).

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  Fig. 3 In the ergonovine provocation test, spasm of the left ascending artery (black arrow) was relieved by intracoronary nitroglycerin injection (blank arrow), thereby confirming the diagnosis of coronary artery spasm.

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