Aggressive Treatment of Refractory Coronary Artery Vasospasm in a Patient with Malignant Ventricular Tachyarrhythmia and Cardiac Arrest

Mert Doğan; Ergün Barış Kaya; Çiğdem Deniz; Uğur Canpolat; Mehmet Levent Şahiner; Ahmet Hakan Ateş; Kudret Aytemir

doi:10.58600/eurjther-186

Authors

Mert Doğan Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara https://orcid.org/0000-0002-2965-058X
Ergün Barış Kaya Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara https://orcid.org/0000-0002-4424-3704
Çiğdem Deniz Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara https://orcid.org/0000-0002-2190-0134
Uğur Canpolat Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara https://orcid.org/0000-0002-4250-1706
Mehmet Levent Şahiner Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara https://orcid.org/0000-0002-0985-3144
Ahmet Hakan Ateş Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara https://orcid.org/0000-0001-5414-7268
Kudret Aytemir Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara https://orcid.org/0000-0001-9279-8424

DOI:

https://doi.org/10.58600/eurjther-186

Keywords:

Vasospastic coronary angina, Sudden cardiac arrest, Sympatectomy

Abstract

Coronary artery vasospasm (CAVS) is a clinical entity that can cause angina, but also unstable angina pectoris, acute myocardial infarction, fatal arrhythmias, and sudden death. Although it is a condition that is usually controlled with medical treatment, more aggressive treatments may rarely be required. In this case, the patient with a known diagnosis of CAVS had multiple arrests despite optimal medical treatment. We observed that fatal arrhythmias persisted in the Implantable Cardioverter Defibrillator (ICD) records, even though we implanted a stent and gave the patient maximal medical treatment. We performed sympathectomy as a last resort and we did not detect any recurrence in the 6-month follow-up of the patient. ICD implantation and sympathectomy should always be considered in resistant CAVS cases.