Date of Presentation

5-4-2023 12:00 AM

College

School of Osteopathic Medicine

Poster Abstract

Background: Coronary artery vasospasm (CAV) is transient spasm of a coronary artery that can lead to cardiac ischemia. We present a case with left main (LM) CAV identified on electrocardiogram (ECG) and cardiac catheterization resulting in appropriate therapy.

Case: A 52 year old female with months of spontaneously resolving episodic neck pain, flushing, and diaphoresis presented to the emergency department after a resuscitated cardiac arrest. Initial ECG was without evidence of ischemia, however high-sensitivity troponin (522) was elevated. Telemetry monitoring and ECG showed transient ST elevations in V1 and diffuse ST depressions with left bundle branch block. LV Function was preserved on transthoracic echocardiogram(TTE)

Decision Making: The intermittent ischemic changes on ECG, normal TTE findings, and reported episodic symptoms prompted emergent cardiac catheterization. Upon engagement of the LM coronary artery, CAV was observed and resolved with 225 mcg of intracoronary nitroglycerine. Therapy with calcium channel blocker and nitrate therapy was initiated with symptom and ECG resolution. In consultation with electrophysiology, an ICD was placed for secondary prevention of sudden cardiac death (SCD).

Conclusion: LM CAV should be considered in young patients without risk factors for ACS. Serial EKGs in addition to cardiac catheterization should be performed. Management of LM CAV post cardiac arrest should include medical management in addition to ICD placement to prevent SCD.

Keywords

Coronary Vasospasm, Cardiac Ischemia, Case Reports, Diagnosis

Disciplines

Cardiology | Cardiovascular Diseases | Diagnosis | Emergency Medicine | Medicine and Health Sciences

Document Type

Poster

Share

COinS
 
May 4th, 12:00 AM

A Rare Case of Left Main Vasospasm Resulting in Sudden Cardiac Death

Background: Coronary artery vasospasm (CAV) is transient spasm of a coronary artery that can lead to cardiac ischemia. We present a case with left main (LM) CAV identified on electrocardiogram (ECG) and cardiac catheterization resulting in appropriate therapy.

Case: A 52 year old female with months of spontaneously resolving episodic neck pain, flushing, and diaphoresis presented to the emergency department after a resuscitated cardiac arrest. Initial ECG was without evidence of ischemia, however high-sensitivity troponin (522) was elevated. Telemetry monitoring and ECG showed transient ST elevations in V1 and diffuse ST depressions with left bundle branch block. LV Function was preserved on transthoracic echocardiogram(TTE)

Decision Making: The intermittent ischemic changes on ECG, normal TTE findings, and reported episodic symptoms prompted emergent cardiac catheterization. Upon engagement of the LM coronary artery, CAV was observed and resolved with 225 mcg of intracoronary nitroglycerine. Therapy with calcium channel blocker and nitrate therapy was initiated with symptom and ECG resolution. In consultation with electrophysiology, an ICD was placed for secondary prevention of sudden cardiac death (SCD).

Conclusion: LM CAV should be considered in young patients without risk factors for ACS. Serial EKGs in addition to cardiac catheterization should be performed. Management of LM CAV post cardiac arrest should include medical management in addition to ICD placement to prevent SCD.

 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.