Worsening of coronary spasm during the perioperative period:A case report

We present the case of a 65-year-old male with vasospastic angina(VSA)whose condition worsened during the perioperative period.He had been diagnosed with VSA 10 years prior.He was treated with two types of vasodilators and had not experienced any chest symptoms for 5 years.At this juncture,he underw...

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Bibliographic Details
Published inWorld Journal of Cardiology Vol. 6; no. 7; pp. 685 - 688
Main Author Teragawa, Hiroki
Format Journal Article
LanguageEnglish
Published United States Baishideng Publishing Group Inc 26.07.2014
Subjects
Case Report
Coronary
Discontinuation
period
Perioperative
vasodilator
vasospasm
Coronary vasospasm
Perioperative period
Discontinuation of vasodilator
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ISSN1949-8462
1949-8462
DOI10.4330/wjc.v6.i7.685

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Summary:We present the case of a 65-year-old male with vasospastic angina(VSA)whose condition worsened during the perioperative period.He had been diagnosed with VSA 10 years prior.He was treated with two types of vasodilators and had not experienced any chest symptoms for 5 years.At this juncture,he underwent surgery for relapsed maxillary sublingual carcinoma.He had taken two vasodilators one day prior to surgery.Intravenous infusion of nitroglycerin(NTG)was initiated immediately before the surgery and continued the following day.Instead of stopping NTG,a dermal isosorbide dinitrate tape was applied on post-operative day 1.Two days later,a complete atrioventricular block with pulseless electrical activity appeared.After cardiopulmonary resuscitation,emergent coronary angiography showed severe coronary spasm in both the left and right coronary arteries.Intracoronary infusion of nitroglycerin and epinephrine with percutaneous cardiopulmonary support relieved the coronary spasm.During the perioperative period,several factors can trigger coronary vasospasm,including the discontinuation of vasodilators.Thus,surgeons,anesthetists,and cardiologists should watch for coronary vasospasm during this period and for worsening coronary spasm when discontinuing vasodilators in patients at risk for VSA.
Bibliography:Hiroki Teragawa;Kenji Nishioka;Yuichi Fujii;Naomi Idei;Takaki Hata;Shuji Kurushima;Tomoki Shokawa;Yasuki Kihara;Department of Cardiovascular Medicine,Hiroshima University Hospital
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Correspondence to: Hiroki Teragawa, MD, PhD, Department of Cardiovascular Medicine, Hiroshima General Hospital of the West Japan Railway Company, 3-1-36 Futabanosato, Higashi-ku, Hiroshima 734-8551, Japan. hiroteraga71@gmail.com
Telephone: +81-82-2621171 Fax: +81-82-2621499
Author contributions: Teragawa H wrote the manuscript; Nishioka K, Fujii Y, Idei N, Hata T, Kurushima S and Shokawa T collected data; Kihara Y evaluated the study and revised the manuscript.
ISSN:1949-8462
1949-8462
DOI:10.4330/wjc.v6.i7.685