A patient with multiple sudden cardiac arrests due to coronary spasm

Corsia A, Dubourdieu S, Jost D, Tourtie r JP, Domanski L, Segal N. A patient with multiple sudden cardiac arrests due to coronary spasm. Med Emergency, MJEM 2014; 21:20-2.

  • Authors’ affiliation
  • Article history / info
  • Conflict of interest statement
Correspondent author: Nicolas SEGAL, MD, PhD

Department of Emergency Medicine, Lariboisière University Hospital

2, rue Ambroise Paré, 75010, Paris, France

dr.nicolas.segal@gmail.com

Corsia A, MD2, Dubourdieu S, MD3, Jost D ,MD3, Tourtier JP, MD, PhD3, Domanski L, MD3, Segal N, MD, PhD1

1. Emergency Medicine Department, AP-HP, Lariboisière University Hospital, F-75018, Paris, France

2. Emergency Medicine Department, Robert Boulin hospital, 33500, Libourne, France

3. Emergency Medicine Department, Fire Brigade of Paris, France

Category: Case report

Received: Oct 1, 2014

Revised: Oct 22, 2014

Accepted: Nov 5, 2014

There is no conflict of interest to declare

ABSTRACT

Aim: To report the case of a patient suffering multiple cardiac arrests due to coronary spasm. Prinzmetal’s angina which is underdiagnosed can be responsible for myocardial ischemia with all its resulting complications, the most severe being conductive and ventricular rhythm disorders and asystole.

Methods: The Paris fire brigade’s basic life support and mobile intensive care unit team’s records as well as inpatient hospital records were the data sources for this report. The patient’s consent was obtained before any data was utilized.

Case Report: A 66-year-old man with a long history (years) of undiagnosed fainting spells suffered four cardiac arrests the same morning. After two successful returns of spontaneous circulation resuscitative efforts, the patient exhibited a completely normal cardiovascular and neurological profile. After the second cardiac arrest, he complained of typical chest pain. Initially his ECG showed atrial fibrillation without any heart block or repolarisation abnormalities. After the cardiac arrest it changed to an inferior and lateral ST depression and then to an inferior ST elevation. His coronarography showed no acute coronary lesion. Nonetheless, the Methergin® test confirmed a Prinzmetal’s angina diagnosis.

Conclusion: The Prinzmetal’s angina or angina inversa are terms used to indicate a clinical and physiopathological entity different from traditional angina. The guideline for resuscitation should discuss the use of adrenaline (epinephrine) in this particular setting where its alpha effects may worsen the spasms.