Abstract
We present three patients without significant coronary or other structural heart disease who were resuscitated after ventricular fibrillation attributed to coronary spasm. Angina pectoris was present in two of the cases and silent myocardial ischemia in the third. All patients were given calcium antagonists at discharge. A defibrillator was also implanted in the patient with silent myocardial ischemia because further episodes of ischemia would probably have occurred without premonitory symptoms. Coronary spasm might be a mechanism of ventricular fibrillation in patients without significant structural heart disease. Diagnostic tests should therefore be performed to confirm or exclude coronary spasm in such cases. The implantation of an automatic defibrillator seems justified in selected patients with documented coronary spasm, silent myocardial ischemia, and associated sustained ventricular tachyarrhythmia, although prospective studies are not yet available.
Similar content being viewed by others
References
Brooks R, McGovern BA, Garan H, Ruskin JN (1991) Current treatment of patients surviving out-of-hospital cardiac arrest. JAMA 265:762–768
Cosby RS, Giddings JA, See JR, Mayo M (1972) Variant angina. Case reports and critique. Am J Med 53:739–742
DiMarco JP (1992) Coronary artery spasm, silent ischemia, and cardiac arrest. N Engl J Med 326:1490–1491
Dubuc M, Lalonde G, Page P, Shenasa M (1989) Variant angina and sudden death: use of an implantable defibrillator. J Electrophysiol 3:81–83
Fellows CL, Weaver WD, Greene HL (1987) Cardiac arrest associated with coronary artery spasm. Am J Cardiol 60:1397–1399
Freedman SB, Richmond DR, Kelly DT (1983) Clinical studies of patients with coronary spasm. Am J Cardiol 52:67A-71A
Kerin NZ, Rubenfire M, Naini M, Wajszczuk WJ, Pamatmat A, Cascade PN (1979) Arrhythmias in variant angina pectoris. Relationship of arrhythmias to ST-segment elevation and R-wave changes. Circ 60:1143–1150
Levi GF, Proto C (1973) Ventricular fibrillation in the course of Prinzmetal's angina pectoris. Report of two cases. Br Heart J 35:601–603
Maseri A, Severi S, Marzullo P (1982) Role of coronary arterial spasm in sudden coronary ischemic death. Ann NY Acad Sci 382:204–217
Miller DD, Waters DD, Szlachcic J, Theroux P (1982) Clinical characteristics associated with sudden death in patients with variant angina. Circ 66:588–592
Morady F, DiCarlo L, Winston S, Davis JC, Scheinman MM (1984) Clinical features and prognosis of patients with out of hospital cardiac arrest and a normal electrophysiologic study. J Am Coll Cardiol 4:39–44
Myerburg RJ, Kessler KM, Mallon SM, Cox MM, deMarchena E, Interian A Jr, Castellanos A (1992) Life-threatening ventricular arrhythmias in patients with silent myocardial ischemia due to coronary artery spasm. N Engl J Med 326:1451–1455
Prchkov VK, Mookherjee S, Schiess W, Obeid AI (1974) Variant anginal syndrome, coronary artery spasm, and ventricular fibrillation in absence of chest pain. Ann Intern Med 81:858–859
Previtali M, Klersy C, Salerno JA, Chimienti M, Panciroli C, Marangoni E, Specchia G, Comolli M, Bobba P (1983) Ventricular tachyarrhythmias in Prinzmetal's variant angina: clinical significance and relation to the degree and time course of S-T segment elevation. Am J Cardiol 52:19–25
Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N (1959) Angina pectoris. 1. A variant form of angina pectoris: preliminary report. Am J Med 27:375–388
Rapaport E (1988) Sudden cardiac death. Am J Cardiol 62:31–61
Robertson RM, Wood AJJ, Vaughn WK, Robertson D (1982) Exacerbation of vasotonic angina pectoris by propranolol. Circ 65:281–285
Rutherford JD, Braunwald E (1992) Chronic ischemic heart disease. In: Braunwald E (ed) Heart disease: a textbook of cardiovascular medicine. Saunders, Philadelphia, pp 1292–1364
Salerno JA, Previtali M, Chimienti M, Klersy C, Bobba P (1984) Vasospasm and ventricular arrhythmias. Ann NY Acad Sci 427:222–233
Author information
Authors and Affiliations
Additional information
Correspondence to: S. Behrens
Rights and permissions
About this article
Cite this article
Behrens, S., Andresen, D., Brüggemann, T. et al. Ventricular fibrillation related to coronary spasm in patients without significant coronary or other structural heart disease. Clin Investig 72, 307–312 (1994). https://doi.org/10.1007/BF00180046
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00180046