Riaz Sana, Raj Vijay, Shah Siddharth
Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA.
Cardiovascular Medicine, State University of New York Upstate Medical University, Syracuse, USA.
Cureus. 2020 Aug 8;12(8):e9613. doi: 10.7759/cureus.9613.
Vasospastic angina (VSA) is characterized by episodic chest pain associated with transient ST-segment abnormalities on electrocardiogram, secondary to vasospasm of the epicardial coronary artery. We report the rare case of a 46-year-old female with refractory VSA secondary to multivessel coronary vasospasm causing an anterior myocardial infarction. She succumbed secondary to ventricular tachycardia (VT) storm, in spite of being on maximally tolerated medical therapy and having an implantable cardioverter defibrillator (ICD) for secondary prevention of VT. Contemporary guidelines recommend ICD implantation (class IIa) in VSA patients who survived sudden cardiac arrest (SCA), if they are already on optimal medical therapy or if medical therapy is not tolerated. Whether ICD implantation is appropriate in VSA patients with aborted SCA, even before assessing the response to medical therapy, is not well known and requires further studies.
变异性心绞痛（VSA）的特征是发作性胸痛，并伴有心电图上短暂的ST段异常，这是由心外膜冠状动脉痉挛继发引起的。我们报告了一例罕见病例，一名46岁女性患有难治性VSA，继发于多支冠状动脉痉挛，导致前壁心肌梗死。尽管接受了最大耐受的药物治疗并植入了植入式心脏复律除颤器（ICD）用于二级预防室性心动过速（VT），但她仍死于室性心动过速风暴。当代指南建议，对于已发生心脏骤停（SCA）且存活下来的VSA患者，如果他们已经接受了最佳药物治疗或无法耐受药物治疗，则应植入ICD（IIa类）。对于即使在评估药物治疗反应之前就发生过SCA未遂的VSA患者，ICD植入是否合适尚不清楚，需要进一步研究。
