Vnitr Lek 2007, 53(6):724-728

Malignant arrhythmia in a patient with variant (Prinzmetal's) angina pectoris

T. Skála*, M. Hutyra, J. Galuszka, M. Fedorco, R. Husár, M. Richter, J. Lukl
I. interní klinika Lékařské fakulty UP a FN Olomouc, přednosta prof. MUDr. Jan Lukl, CSc.

Malignant arrhythmia is a frequent complication of myocardial ischemia due to the occurrence of coronary artery spasm. The paper describes a patient with variant angina pectoris with an ICD implant who was repeatedly resuscitated for circulatory arrest in malignant arrhythmia. During myocardial ischemia the ECG showed elevations in the ST segments in the region of the ventral cardiac wall, with the formation of permanent polymorphous chamber tachycardia. External defibrillation was necessary due to recurrent tachyarrhythmias. A spasm developed when the RIA (radio immuno assay) was introduced during coronarography. The spasm started in the periphery of the artery and extended as far as the area of bifurcation with RD, with transitory closure of the artery and the development of chamber tachycardia. The patient fully recovered after the addition of Ca-blocker, nitrate depot and the withdrawal of the beta-blocker.

Keywords: variant angina pectoris; coronary spasm; malignant arrhythmia; coronarography; provocation tests; hyperventilation echocardiography

Received: November 22, 2006; Accepted: January 25, 2007; Published: June 1, 2007  Show citation

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Skála T, Hutyra M, Galuszka J, Fedorco M, Husár R, Richter M, Lukl J. Malignant arrhythmia in a patient with variant (Prinzmetal's) angina pectoris. Vnitr Lek. 2007;53(6):724-728.
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    References

    1. Sovová E, Lukl P, Číhalík Č. Vasospastická angína. Vnitř Lék 2005; 51: 548-554.
    2. Ozaki Y, Keane D, Serruys PW. Fluctuation of spastic location in patients with vasospastic angina: a quantitative angiographic study. J Am Coll Cardiol 1995; 26: 1606-1614. Go to original source... Go to PubMed...
    3. Kaski JC, Maseri A, Vejar M et al. Spontaneous coronary artery spasm in variant angina results from a local hyperreactivity to a generalized constrictor stimulus. J Am Coll Cardiol. 1989; 14: 1456-1463. Go to original source... Go to PubMed...
    4. Kaski JC, Crea F, Meran D et al. Local coronary supersensitivity to diverse vasoconstrictive stimuli in patients with variant angina. Circulation 1986; 74: 1255-1265. Go to original source... Go to PubMed...
    5. Sovová E, Marek D, Škvařilová M et al. Echokardiografický hyperventilační test u pacientů s negativní koronarografií. Vnitř Lék 2001; 47: 156-160. Go to PubMed...
    6. Nobuyoshi M, Abe M, Nosaka H et al. Statistical analysis of clinical risk factors for coronary artery spasm: identification of the most important determinant. Am Heart J 1992; 124: 32-38. Go to original source... Go to PubMed...
    7. Sugiishi M, Takatsu F. Cigarette smoking is a major risk factor for coronary spasm. Circulation 1993; 87: 76-79. Go to original source... Go to PubMed...
    8. Ujhelyi E, Bohm A, Toth C et al. Prinzmetal angina pectoris associated with 3rd degree atrioventricular block. Orv Hetil 2001; 142: 1809-1811. Go to PubMed...
    9. Kreuzer J, von Hodenberg E, Jahn L et al. Recurrent ventricular fibrillation in a patient with angiographically normal coronary arteries and intermittent ST segment elevation. Z Kardiol 1990; 79: 592-598.
    10. Parchure A, Batchvarov V, Malik M et al. Increased QT dispersion in patients with Prinzmetal's variant angina and cardiac arrest. Cardiovasc Res 2001; 50: 379-385. Go to original source... Go to PubMed...
    11. Nakao K, Ohgushi M, Zoshimura M et al. Hyperventilation as a specific test for diagnosis of coronary artery spasm. Am J Cardiol 1997; 80: 545-549. Go to original source... Go to PubMed...
    12. Hamilton KK, Pepine CJ. A renaissance of provocative testing for coronary spasm? J Am Coll Cardiol 2000; 35: 1857-1859. Go to original source... Go to PubMed...
    13. Chahine RA, Feldman RL, Giles TD et al. Randomized placebo-controlled trial of amlodipine in vasospastic angina. Amlodipine Study 160 Group. J Am Coll Cardiol 1993; 21: 1365-1370. Go to original source... Go to PubMed...
    14. Yasue H, Touyama M, Kato H et al. Prinzmetal's variant form of angina as a manifestation of alpha-adrenergic receptor-mediated coronary artery spasm: documentation by coronary arteriography. Am Heart J 1976; 91: 148-155. Go to original source... Go to PubMed...
    15. Yasue H, Takizawa A, Nagao M. Long-term prognosis for patients with variant angina and influential factors. Circulation 1988; 78: 19. Go to original source... Go to PubMed...
    16. Bory M, Pierron F, Panagides D et al. Coronary artery spasm in patients with normal or near normal coronary arteries. Long-term follow-up of 277 patients. Eur Heart J 1996; 17: 1015-1021. Go to original source... Go to PubMed...
    17. Rovai D, Bianchi M, Baratto M et al. Organic coronary stenosis in Prinzmetal's variant angina. J Cardiol 1997; 30: 299-305.
    18. Walling A, Waters DD, Miller DD et al. Long-term prognosis of patients with variant angina. Circulation 1987; 76: 990-997. Go to original source... Go to PubMed...
    19. Gupta S et al. Coronary stent for variant angina: atypical presentation. Cathet Cardiovasc Diagn 1998; 45: 439-441. Go to original source... Go to PubMed...
    20. Shin DL et al. Therapy options for Prinzmetal angina induced ventricular vulnerability. Z Kardiol 2003; 92: 332-338. Go to original source... Go to PubMed...

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