Malignant arrhythmia in a patient with variant (Prinzmetal’s) angina pectoris

Česká verzia

Authors: T. Skála; M. Hutyra; J. Galuszka; M. Fedorco; R. Husár; M. Richter; J. Lukl
Authors place of work: I. interní klinika Lékařské fakulty UP a FN Olomouc, přednosta prof. MUDr. Jan Lukl, CSc.
Published in the journal: Vnitř Lék 2007; 53(6): 724-728
Category: Case Reports

Summary

Malignant arrhythmia is a frequent complication of myocardial ischemia due to the occurrence of coronary artery spasm. The paper describes a patient with variant angina pectoris with an ICD implant who was repeatedly resuscitated for circulatory arrest in malignant arrhythmia. During myocardial ischemia the ECG showed elevations in the ST segments in the region of the ventral cardiac wall, with the formation of permanent polymorphous chamber tachycardia. External defibrillation was necessary due to recurrent tachyarrhythmias. A spasm developed when the RIA (radio immuno assay) was introduced during coronarography. The spasm started in the periphery of the artery and extended as far as the area of bifurcation with RD, with transitory closure of the artery and the development of chamber tachycardia. The patient fully recovered after the addition of Ca-blocker, nitrate depot and the withdrawal of the beta-blocker.

Key words:
variant angina pectoris – coronary spasm – malignant arrhythmia – coronarography – provocation tests – hyperventilation echocardiography

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