Zhang Zhi-Ping, Su Xi, Yang Yu-Chun, Wu Ming-Xiang, Liu Bo, Liu Chen-Wei
Cardiac Care Unit, Wuhan Asia Heart Hospital, Wuhan, 430022,China.
Cardiac Care Unit, Wuhan Asia Heart Hospital, Wuhan, 430022,China.
Am J Emerg Med. 2015 Mar;33(3):479.e5-6. doi: 10.1016/j.ajem.2014.08.052. Epub 2014 Aug 27.
Coronary artery spasm can lead to sudden cardiac death due to ventricular arrhythmias or heart block. Cardiopulmonary resuscitation guidelines recommend the use of epinephrine during cardiopulmonary arrest. However, in the event of cardiac arrest caused by coronary artery spasm, the use of epinephrine may be harmful. We report 2 cases who had witnessed cardiac arrest due to ventricular fibrillation and complete heart block. Intravenous epinephrine was administered during resuscitation.Their hemodynamics did not improve. Emergent coronary angiography revealed that the entire right and left coronary artery systems diffuse spasm. One patient's coronary artery spasm was successfully reversed immediately with administration of intracoronary boluses of nitroglycerin. The other patient's hemodynamic instability persisted,requiring temporary mechanical circulatory support with an intra aortic balloon pump. His hemodynamics finally improved with administration of intravenous diltiazem and nitroglycerin under the intraaortic balloon pump support. They both were discharged from the hospital without any other complications.
冠状动脉痉挛可因室性心律失常或心脏传导阻滞导致心源性猝死。心肺复苏指南推荐在心肺骤停期间使用肾上腺素。然而，在由冠状动脉痉挛引起的心脏骤停情况下，使用肾上腺素可能有害。我们报告2例因心室颤动和完全性心脏传导阻滞而发生目击心搏骤停的病例。复苏期间给予了静脉注射肾上腺素。他们的血流动力学并未改善。急诊冠状动脉造影显示整个右冠状动脉和左冠状动脉系统弥漫性痉挛。1例患者经冠状动脉内注射硝酸甘油后，冠状动脉痉挛立即成功逆转。另一例患者的血流动力学不稳定持续存在，需要使用主动脉内球囊泵进行临时机械循环支持。在主动脉内球囊泵支持下，给予静脉注射地尔硫䓬和硝酸甘油后，其血流动力学最终得到改善。他们均出院，无任何其他并发症。
