An Unusual Case of Vasospastic Angina Resulting in Multiple Episodes of Cardiac Arrest

TL;DR

A rare case of vasospastic angina led to multiple cardiac arrests, which were successfully managed with specific medications.

Contribution

This case highlights an uncommon cause of cardiac arrest and effective treatment with calcium channel blockers and nitroglycerin.

Findings

Coronary vasospasm caused multiple episodes of pulseless electrical activity cardiac arrest.

Treatment with dihydropyridine calcium channel blocker and nitroglycerin patch prevented further episodes.

Telemetry confirmed ST-segment elevation preceding cardiac arrest events.

Abstract

Coronary vasospasm is a well-recognized cause of angina (also known as Prinzmetal angina) and a common cause of admissions to the emergency department and coronary intensive care units. It is however an uncommon cause of cardiac arrest. We describe a patient with multiple episodes of chest pain followed by cardiac arrest in pulseless electrical activity (PEA) due to coronary vasospasm. Telemetry and electrocardiography showed ST-segment elevation followed by PEA. Each event was short-lived and resolved after a maximum of six minutes of advanced life support measures. The patient was started on treatment with a dihydropyridine calcium channel blocker (CCB) and nitroglycerin patch with no further episodes recorded to date.

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