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Shin, Cho, Lee, Lee, and Lim: Coronary Spastic Angina and Life Threatening Arrhythmia despite Nitroglycerine Infusion
Case Report

The Ewha Medical Journal 2014; 37(1): 56-59.

Published online: 25 March 2014

DOI: https://doi.org/10.12771/emj.2014.37.1.56

Coronary Spastic Angina and Life Threatening Arrhythmia despite Nitroglycerine Infusion

Kyoung Hwang Shin, Woo Hee Cho, Do Hyun Lee, Sora Lee, Seong-Hoon Lim

Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.

Corresponding author: Seong-Hoon Lim. Department of Internal Medicine, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 330-715, Korea. Tel: 82-41-550-7690, Fax: 82-41-556-8122, shlimd@dankook.ac.kr

Received 26 September 2013       Accepted 22 October 2013

Copyright © 2014. Ewha Womans University School of Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Variant angina pectoris is characterized by chest symptoms at rest and transient ST elevation on the electrocardiography due to coronary artery spasm. Although most patients with coronary spasm respond well to medical treatment with vasodilators such as calcium channel blockers and nitrates, some patients show intractable attack of coronary vasospasm despite standard medical therapy. We experienced 50-year-old woman with intractable chest pain due to coronary artery spasm, who suffered from ventricular fibrillation despite continuous intravenous nitrate therapy.

Keywords: Coronary vasospasm, Cardiac arrhythmia, Variant angina pectoris

Figures and Tables

Fig. 1
Electrocardiogram (ECG) on admission. (A) ECG shows ST segment elevation in inferior leads (II, III, aVF). (B) The ECG shows complete remission of ST segment elevation after intravenous nitroglycerin.
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Fig. 2
ECG after intravenous infusion of nitrates. It shows ventricular fibrillation which is developed despite the intravenous infusion of nitrates.
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Fig. 3
Coronary angiogram. (A) Coronary angiogram reveals a severe spasm in the proximal and distal portion of right coronary artery. (B) The proximal and distal spasms of the right coronary artery are improved by repeated intracoronary injection of nitroglycerine.
emj-37-56-g003

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