Department of Emergency, Tokyo Kita Medical Center, Kita-ku, Japan
Department of Cardiology, Tokyo Kita Medical Center, Kita-ku, Japan.
BMJ Case Rep. 2021 Aug 23;14(8):e244693. doi: 10.1136/bcr-2021-244693.
The underlying mechanisms of coronary spastic angina (CSA) is not well understood. It is unclear if an infection can trigger coronary vasospasm; the co-occurrence of sepsis and CSA has rarely been reported. We describe the case of a 47-year-old man who suddenly developed a complete atrioventricular block and an episode of cardiac arrest while undergoing treatment for sepsis secondary to invasive group A streptococci. Emergency coronary angiography and provocation revealed spasm of the right coronary artery, which had led to the atrioventricular block. The spasm was relieved following administration of calcium-channel blockade, and no subsequent recurrence was documented. Due to several underlying mechanisms, sepsis may be a potential risk factor of coronary spasm and episodes of this condition have been missed or misdiagnosed. Physicians should be aware of CSA as a potential complication during treatment of sepsis.
冠状动脉痉挛性心绞痛（CSA）的潜在机制尚不清楚。目前尚不清楚感染是否会引发冠状动脉痉挛；脓毒症和 CSA 同时发生的情况很少见。我们描述了一例 47 岁男性的病例，该患者在因侵袭性 A 组链球菌引起的脓毒症接受治疗时突然出现完全性房室传导阻滞和心搏骤停。紧急冠状动脉造影和激发试验显示右冠状动脉痉挛，导致房室传导阻滞。钙通道阻滞剂治疗后痉挛缓解，且未记录到后续复发。由于多种潜在机制，脓毒症可能是冠状动脉痉挛的一个潜在危险因素，这种情况可能被漏诊或误诊。医生应该意识到 CSA 是治疗脓毒症时的一种潜在并发症。
