Ewha Med J.  2022 Oct;45(4):e17. 10.12771/emj.2022.e17.

Coronary Spasm during General Anesthesia in a Patient with Previously Undiagnosed Variant Angina

• Lee GY
• Cho S
• Kim DY
• Yoo SH

• KMID: 2534742
• DOI: http://doi.org/10.12771/emj.2022.e17

Abstract

Variant angina, which is associated with coronary artery spam, is difficult to recognize on routine preoperative evaluation. Coronary spasm results in myocardial ischemia and even lethal arrhythmia in severe cases. Since patients are unconscious and cannot complain of symptoms during general anesthesia, early detection of such an event is difficult, and it could lead to severe bradycardia or cardiac arrest. We report a case of a patient with previously undiagnosed variant angina who experienced severe hypotension and ventricular fibrillation during general anesthesia.

Keyword

Coronary vasospasm; Anesthesia; general; Hypotension; Angina pectoris; variant; Ventricular fibrillation

Figure

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  Fig. 1. Electrocardiography following coronary vasospasm. (A) ST-segment elevation at the leads V2–V4 was noted when the patient’s blood pressure decreased. Immediately following this observation, ventricular fibrillation was noted. After one cycle of cardiopulmonary resuscitation, a return of spontaneous circulation (ROSC) was achieved. (B) ST-segment elevation normalized shortly after ROSC.

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  Fig. 2. Emergency coronary angiography. (A) and (B) No stenotic lesions were detected in the left and right coronary arteries. (C) Dilation of the right coronary artery was observed after intravenous administration of nitroglycerin.

Reference

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