scholarly journals The Challenges of Treating Acute Myocardial Infarction due to Variant Angina: Lesson from an Interesting Case

2020 ◽  
Author(s):  
Guo-Hua Li
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Artery Spasm ◽  
Interesting Case ◽  
Variant Angina ◽  
St Segment Elevation ◽  
St Segment

Coronary artery spasm can cause recurrent variant angina with ST-segment elevation. The patient was asymptomatic with normal vitals and ECG was normal. We present a case associated with transient ST-segment elevation and significant increase in troponin levels with non-critical lesion with normal CAG

scholarly journals Recurrent Coronary Artery Spasm Induced by Vasopressors During Two Operations in the Same Patient Under General Anesthesia

2018 ◽  
Vol 65 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Naotaka Kishimoto ◽  
Munenori Kato ◽  
Yasunori Nakanishi ◽  
Akari Hasegawa ◽  
Yoshihiro Momota
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
General Anesthesia ◽  
Computed Tomography Angiography ◽  
Coronary Artery Spasm ◽  
Variant Angina ◽  
St Segment Elevation ◽  
Know How ◽  
St Segment

Variant angina is caused by coronary artery spasm (CAS) with ST-segment elevation. We herein report a case of recurrent CAS during 2 operations in the same patient. An 80-year-old woman was scheduled to undergo tracheostomy, submandibular dissection, left partial maxillectomy, and coronoidectomy. We administered ephedrine and phenylephrine to manage hypotension during general anesthesia. Immediately after the administration of these drugs, the ST segment elevated. We decided to cease the operation and transport the patient to the department of cardiology. Computed tomography angiography revealed pneumomediastinum. The cardiologists considered that the electrocardiography findings had changed secondary to pneumomediastinum. About 6 weeks later, a second operation was scheduled. We administered ephedrine and phenylephrine to manage hypotension during general anesthesia. Immediately after the administration of these drugs, ST-segment elevation occurred. We discontinued use of these drugs, and the ST-segment elevation did not recur. We considered that the cause of the ST-segment elevation was vasopressor-induced CAS because the vasopressors were administered immediately before the occurrence of CAS. Vasopressors such as ephedrine or phenylephrine are frequently used to manage hypotension during general anesthesia. Therefore, anesthesiologists should consider the occurrence of CAS before using vasopressors and know how to manage CAS well.

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