Recurrent Vasospastic Angina Presenting as Recurrent Cardiac Arrest and Ventricular Fibrillation

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Journal of Emergency Medicine Case Reports
Cilt: 16 Sayı: 4
Recurrent Vasospastic Angina Presenting as Recurrent Cardiac Arrest and Ventricular Fibrillation

Recurrent Vasospastic Angina Presenting as Recurrent Cardiac Arrest and Ventricular Fibrillation

Authors : Ömer Jaradat, Sinem Deniz

Pages : 140-143

Doi:10.33706/jemcr.1751255

View : 82 | Download : 231

Publication Date : 2025-12-31

Article Type : Other Papers

Abstract :Introduction: Vasospastic angina (VSA) is a potentially lethal cause of myocardial ischemia characterized by transient coronary vasospasm. While typically manageable, it can provoke life-threatening ventricular arrhythmias and cardiac arrest. Case Presentation: A 45-year-old woman experienced three cardiac arrests over 15 months. Each event featured ST-elevation on ECG and critical multi-vessel spasm (LMCA, LAD, LCx) confirmed angiographically, resolving with intracoronary nitroglycerin. Initial treatment with diltiazem and nitrates failed to prevent recurrences, complicated by medication non-adherence. An ICD implanted after the second arrest delivered shocks. After the third arrest, reduced LVEF (35-40%) necessitated switching from diltiazem to nebivolol (5 mg/day), while isosorbide mononitrate (40 mg/day) was continued with a nitrate-free interval. At 5-month follow-up, the patient remained symptom-free on this regimen. Conclusion: This case illustrates VSA’s life-threatening potential, including refractory ventricular arrhythmias and recurrent arrest. It underscores the critical role of sustained pharmacotherapy adherence and ICDs in high-risk patients.
Keywords : Vazospastik anjin, Prinzmetal anjini, Koroner vazospazm, Kardiyak arrest, İntrakoroner nitrat, İlaç uyumu

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