Anesth Pain Med.  2013 Apr;8(2):99-103.

Coronary artery spasm following intravenous phenylephrine on a patient under general anesthesia with previously undiagnosed variant angina and successful treatment by nitroglycerin: A case report

• Kim YL
• Kim EJ
• Seo DM
• Lee JH
• Lee SG
• Ban JS

Abstract

Coronary artery spasm under general anesthesia induces interruption of blood flow of coronary arteries and can be detected by a sudden ST elevation on electrocardiogram, which may be followed by severe cardiovascular complications. We have experienced a case of a sudden ST elevation on a 52-year-old patient with no history of coronary artery diseases undergoing spine surgery under general anesthesia. Following administration of nitroglycerin, ST elevation returned to normal. Postoperative coronary angiogram showed positive on ergonovine provocation test and the patient was diagnosed as variant angina. Correlating with the results, we concluded that the ST elevation was probably due to coronary artery spasm. Although the definite mechanism of the coronary artery spasm is unclear. A-adrenergic stimulation by phenylephrine may have acted as a solitary factor or as one of many factors. Early administration of nitroglycerin and calcium channel blocker seems to be useful in treatment and prevention of recurrence.

Keyword

Coronary artery spasm; Nitroglycerin; Phenylephrine; ST elevation; Variant angina

MeSH Terms

Anesthesia, General
Calcium Channels
Coronary Artery Disease
Coronary Vessels
Electrocardiography
Ergonovine
Humans
Nitroglycerin
Phenylephrine
Recurrence
Spasm
Spine
Calcium Channels
Ergonovine
Nitroglycerin
Phenylephrine