Ventricular tachycardia and acute myocardial infarction induced by coronary artery spasm in patient without coronary artery disease
Keywords:Coronary artery spasm, Vasospastic angina, Vasospasm, Ventricular tachycardia, Acute myocardial infarction
Coronary artery spasm, marked by coronary vasoconstriction, is one of the etiologies of myocardial ischemia, often presenting as vasospastic angina. Vasospastic angina is diagnosed when angina which predominantly occurs at rest, is accompanied by ST-segment changes in ECG, or in the setting of borderline ECG changes, a positive provocation test through coronary angiography is required. Although coronary artery spasms could manifest in wide clinical settings, the occurrence of ventricular arrhythmias and acute myocardial infarction solely caused by spasms without evidence of prior coronary artery disease is rare. This case report is about a 46-year-old man who presented with ventricular tachycardia and acute myocardial infarction that later was found to be secondary to coronary vasospasm observed directly through coronary angiography. We aim to emphasize the importance of coronary artery spasms as the etiology of malignant ventricular arrhythmias and acute myocardial infarction manifestation. Optimization in treatment and prevention shall reduce future life-threatening complications of coronary artery spasms.
JCS Joint Working Group. Guidelines for Diagnosis and Treatment of Patients with Vasospastic Angina (Coronary Spastic Angina) (JCS 2013). Circulation J. 2014;78(11):2779-801.
Knuuti J. ESC guidelines for the diagnosis and management of chronic coronary syndromes the task force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Russ J Cardiol. 2020;25(2):119-80.
Beltrame JF, Crea F, Kaski JC, Ogawa H, Ong P, Sechtem U, et al. International standardization of diagnostic criteria for vasospastic angina. Eur Heart J. 2015;38:2565-8.
Cho SW, Park TK, Gwag HB, Lim AY, Oh MS, Lee DH, et al. Clinical outcomes of vasospastic angina patients presenting with acute coronary syndrome. J Am Heart Asso. 2016;5(11).
Beltrame JF, Crea F, Kaski JC, Ogawa H, Ong P, Sechtem U, et al. The who, what, why, when, how and where of vasospastic angina. Circulation J. 2016;80(2):289-98.
Conti CR. Prognostic stratification of patients with vasospastic angina. J Am College Cardiol. 2014;63(15):1585-6.
De Luna AB, Cygankiewicz I, Baranchuk A, Fiol M, Birnbaum Y, Nikus K, et al. Prinzmetal angina: ECG changes and clinical considerations: A consensus paper. Ann Noninvasive Electrocardiol. 2014;19(5):442-53.
Matsue Y, Suzuki M, Nishizaki M, Hojo R, Hashimoto Y, Sakurada H. Clinical implications of an implantable cardioverter-defibrillator in patients with vasospastic angina and lethal ventricular arrhythmia. J Am College Cardiol. 2012;60(10):908-13.
Ahn J-M, Lee KH, Yoo S-Y, Cho YR, Suh J, Shin ES, et al. Prognosis of variant angina manifesting as aborted sudden cardiac death. J Am College Cardiol. 2016;68(2):137-45.
Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction. Euro Heart J. 2018;40(3):237-69.
Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Euro Heart J. 2015;36(41):2793-867.
Bhar-Amato J, Davies W, Agarwal S. Ventricular arrhythmia after acute myocardial infarction: ‘The perfect storm.’ Arrhythmia Electrophysiol Rev. 2017;6(3):134.
Sattler SM, Skibsbye L, Linz D, Lubberding AF, Tfelt-Hansen J, Jespersen T. Ventricular arrhythmias in first acute myocardial infarction: Epidemiology, mechanisms, and interventions in large animal models. Frontiers in Cardiovascular Med. 2019;6.
Takagi Y, Yasuda S, Tsunoda R, Ogata Y, Seki A, Sumiyoshi T, et al. Clinical characteristics and long-term prognosis of vasospastic angina patients who survived out-of-hospital cardiac arrest. Circulation: Arrhythmia Electrophysiol. 2011;4(3):295-302.
Picard F, Sayah N, Spagnoli V, Adjedj J, Varenne O. Vasospastic angina: A literature review of current evidence. Arch Cardiovascular Dis. 2019;112(1):44-55.
Harris JR, Hale GM, Dasari TW, Schwier NC. Pharmacotherapy of vasospastic angina. Journal of Cardiovascular Pharmacology and Therapeutics. 2016;21(5):439-51.
Mori H, Takahashi J, Sato K, Miyata S, Takagi Y, Tsunoda R, et al. The impact of antiplatelet therapy on patients with vasospastic angina: A multicenter registry study of the Japanese coronary spasm association. IJC Heart Vasculature. 2020;29:100561.
Mitchell LB. Use of the implantable cardioverter-defibrillator in patients with coronary artery spasm as the apparent cause of spontaneous life-threatening ventricular tachycardia or ventricular fibrillation. J Am College Cardiol. 2012;60(10):914-6.