Abstract 11375: Hyperventilation Induced Coronary Vasospasm in a Man With Left Main Atresia With a Single Coronary Artery
Introduction: Coronary anomaly accounts for about a 3rd of sudden deaths in young individuals and coronary vasospasm in an anomalous coronary artery is very rare.
Case: A 66 year old male with history of hypertension, diabetes & hyperlipidemia presented with syncope. He reported 2 months of episodic dyspnea, near-syncope, and epigastric pain. Stress cardiac magnetic resonance imaging demonstrated normal myocardial perfusion. While awaiting an electrophysiology study, he was observed to hyperventilate with associated epigastric pain, numbness and tingling followed by syncope with pulseless electrical activity arrest, receiving 2 minutes of cardiopulmonary resuscitation. Post-arrest electrocardiogram demonstrated posterior ST elevation MI so the patient was taken for coronary angiography which revealed congenital left main atresia with a single coronary artery taking the course of the right coronary artery giving rise to the left circumflex via the posterior lateral branch and then the left anterior descending artery (LAD) with mild to moderate disease (Fig 1). During the case, the patient had evidence of dynamic vasospasm in multiple segments that resolved with intracoronary nitroglycerin. All episodes of syncope/pre-syncope occurred after an episode of anxiety and hyperventilation, raising concern for hyperventilation-induced coronary vasospasm. Despite a trial with nifedipine, lorazepam and nitrates, he had another syncopal episode & was referred for coronary artery bypass surgery with left internal mammary artery to the LAD and saphenous vein graft to the obtuse marginal artery.
Discussion: In this rare case, cardiac arrest was a result of coronary vasospasm which would result in global ischemia as the patient only had a single coronary artery, resulting in cardiovascular collapse with drop in cardiac output and pulseless arrest. This is the first case of vasospasm in a single coronary artery.
Author Disclosures: M. Tariq: None. S. Zaheeruddin: None. A. Celarier: None. S. Odonoghue: None. M. Gaglia: None. M. Lipinski: None.
- © 2016 by American Heart Association, Inc.