Case reportDeadly vasospasm☆
Introduction
Prinzmetal's variant angina (PVA) is characterized by spontaneous episodes of chest pain associated with ST segment elevation caused by coronary vasospasm. Associations of PVA with other vasospastic disorders such as Raynaud's phenomenon and migraine headaches have been reported, suggesting the presence of a generalized vasospastic disorder.1 We present a case of PVA associated with lethal cerebral vasospasm.
Section snippets
Case
A 45-year-old man was admitted to the ICU after an out-of-hospital cardiac arrest caused by ventricular fibrillation. One year prior to admission he developed a myocardial infarction. Coronary angiography performed at that time showed normal coronary arteries without any sign of early coronary atherosclerosis. PVA was diagnosed and treated with a calcium channel blocker. His medical history further revealed the use of valproic acid for epilepsy of unknown origin. Before collapsing the patient
Discussion
In 1959 Prinzmetal was the first to describe in detail three typical cases of PVA.2 Patients with this variant type of angina pectoris developed chest pain at rest or during ordinary activity, i.e. in situations were no increase of cardiac work was needed. During such attacks ST segments were elevated with reciprocal depression. The pain almost always terminated spontaneously, but if ischaemia persisted an infarction developed in the same area of the heart that gave rise to the ST elevations.
Conclusion
To our knowledge, the association between PVA and severe cerebral vasospasm has never been described. The combination of severe PVA resulting in ventricular fibrillation and brain death due to severe cerebral vasospasm suggests that this patient had a generalized vasospastic disorder.
Conflict of interest statement
The authors have no conflicts of interest to declare.
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.07.009.