Asymptomatic Coronary Artery Spasm and Severe Ventricular Arrhythmias

SUMMARY 2010;78:445-448 Coronary artery spasm generally evolves with episodes of chest pain and ST elevation. However, there are cases of coronary artery spasm without chest pain with documented ventricular tachyarrhythmias. Its incidence is unknown and it should be included in the differential diagnosis of idiopathic ventricular tachycardia or fibrillation. The case of a patient with history of two syncopal episodes with no apparent structural heart disease is described in this work. Continuous ECG monitoring revealed episodes of ST elevation that led to polymorphic ventricular tachycardia. With the diagnosis of asymptomatic coronary artery spasm, a treatment with calcium channel blockers was begun and an automatic implantable cardioverter defibrillator was implanted. R EV A RGENT C ARDIOL

[1]  R. Brugada,et al.  Multiple episodes of ventricular tachycardia induced by silent coronary vasospasm , 2008, Journal of Interventional Cardiac Electrophysiology.

[2]  H. Yasue,et al.  Coronary artery spasm--clinical features, diagnosis, pathogenesis, and treatment. , 2008, Journal of cardiology.

[3]  M. A. Arias,et al.  Sudden cardiac death during Holter recording in a patient with vasospastic angina. , 2007, International journal of cardiology.

[4]  G. Filippatos,et al.  Secondary prevention of sudden cardiac death in coronary artery spasm: is implantable cardioverter defibrillator always efficient? , 2007, International journal of cardiology.

[5]  B. Strasberg,et al.  Usefulness of implantable cardioverter-defibrillators in refractory variant angina pectoris complicated by ventricular fibrillation in patients with angiographically normal coronary arteries. , 2002, The American journal of cardiology.

[6]  T. Ashikaga,et al.  Polymorphic ventricular tachycardia in patients with vasospastic angina--clinical and electrocardiographic characteristics and long-term outcome. , 2001, Japanese circulation journal.

[7]  P. Touboul,et al.  Arrhythmic cardiac arrest due to isolated coronary artery spasm: long-term outcome of seven resuscitated patients. , 1998, Journal of the American College of Cardiology.

[8]  A. Castellanos,et al.  Life-threatening ventricular arrhythmias in patients with silent myocardial ischemia due to coronary-artery spasm. , 1992, The New England journal of medicine.

[9]  A. Takeshita,et al.  Clinical characteristics associated with myocardial infarction, arrhythmias, and sudden death in patients with vasospastic angina. , 1987, Circulation.