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
Included in
Cardiology Commons, Cardiovascular Diseases Commons, Diagnosis Commons, Emergency Medicine Commons
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.