Prinzmetal Angina Causing Complete Heart Block and Cardiac Arrest
Document Type
Article
Abstract
Background
Prinzmetal angina (PA) occurs due to spontaneous coronary artery spasm. Clinical features of PA may resemble acute coronary syndrome. Complete heart block (CHB) and cardiac arrest due to transient myocardial ischemia are rarely reported. We present a case of CHB with subsequent cardiac arrest resulting from PA during stress testing.
Case
A 55-year-old male with a history of HTN and atrial flutter status post DCCV was hospitalized after cardiac arrest during outpatient exercise stress test. Stress echocardiogram was ordered to evaluate progressive exertional dyspnea. During testing, ECG showed inferior lateral ST elevations. Patient subsequently developed CHB followed by PEA and asystole arrest. After ROSC, catheterization showed significant ostial vasospasm of the left main and right coronary arteries without obstructive disease. Urine drug screen was negative. Patient was transitioned to calcium channel blockade (CCB) as well as long-acting nitrate therapy.
Decision-making
CCB is first-line medical therapy for PA. Current guidelines recommend adding long-acting nitrates for patients who do not adequately respond to CCB. However, as this vasospasm precipitated CHB and cardiac arrest, he was started on CCB and a long-acting nitrate as initial therapy.
Conclusion
In patients with a history of potentially fatal arrhythmias due to PA, early combination therapy with CCB and a long-acting nitrate should be considered to prevent recurrence of arrhythmias or sudden cardiac death.
First Page
2731
DOI
10.1016/S0735-1097(23)03175-3
Publication Date
3-7-2023
Recommended Citation
Schwartz R, Alam A, Shah K, Krinock M, Ferraro B, Durkin MJ. PRINZMETAL ANGINA CAUSING COMPLETE HEART BLOCK AND CARDIAC ARREST. Journal of the American College of Cardiology. 2023 Mar 7;81(8_Supplement):2731-.