Keywords
cardiopulmonary resuscitation
coronary circulation
Prinzmetal’s angina
resuscitation
How to Cite
Abstract
Aim: To report the case of a patient suffering multiple cardiac arrests due to coronary spasm. Prinzmetal’s angina which is under- diagnosed 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.
References
Meune C, Joly LM, Chiche JD, Charpentier J, Leenhardt A, Rosenberg A, et al. Diagnosis and management of out-of-hospital cardiac arrest secondary to coronary artery spasm. Resuscitation 2003; 58:145-52.
Asseza N, Kleinb K, Lefebvrec E, Goldstein P. Prinzmetal’s variant angina or coronary spasm: A rare cause of sudden death. JEUR 2007; 20:133-9 .
Nalenz C, Konradi D, Blank R, Rupprecht HJ. 58-year-old patient with cardiac arrest due to coronary spasm. Clin Res Cardiol 2007; 96:824-8.
Tacoy G, Kocaman SA, Balcioglu S, Tanindi A, Ozdemir M, Cemri M, et al. Coronary vasospastic crisis leading to cardiogenic shock and recurrent ventricular fibrillation in a patient with long-standing asthma. J Cardiol 2008; 52:300-4.
Unverdorben M, Haag M, Fuerste T, Weber H, Vallbracht C. Vasospasm in smooth coronary arteries as a cause of asystole and syncope. Cathet Cardiovasc Diagn 1997; 41:430-4.
Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, et al. European Resuscitation Council Guidelines for Resuscitation 2010: Section 1. Executive summary. Resuscitation 2010; 81:1219-76.
Schultz J, Segal N, Kolbeck J, Caldwell E, Thorsgard M, McKnite S, et al. Sodium nitroprusside enhanced cardiopulmonary resuscitation prevents post-resuscitation left ventricular dysfunction and improves 24-hour survival and neurological function in a porcine model of prolonged untreated ventricular fibrillation. Resuscitation 2011; 82:S35-40.