Colombo Giada, Selimi Adelina, Cesari Andrea, Pedrotti Patrizia, Sacco Alice
Cardiology Department, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162 Milan, Italy.
Eur Heart J Case Rep. 2025 May 28;9(6):ytaf252. doi: 10.1093/ehjcr/ytaf252. eCollection 2025 Jun.
Coronary artery spasm (CAS) is a temporary, severe narrowing of the coronary arteries typically presenting with nitrate-responsive angina at rest, transient ischaemic ECG changes, and in some cases leading to silent myocardial ischaemia, acute myocardial infarction, life threatening arrhythmias and cardiac arrest.
A 47-years-old man with a history of chronic coronary syndrome and a working diagnosis of probable pheochromocytoma was admitted to the Emergency Department after two episodes of out-of-hospital cardiac arrest successfully resuscitated. Transient ST segment elevation was observed, and emergency coronary angiography (CA) revealed no significant coronary stenosis. His history also included past alcohol abuse and ongoing cannabinoid use. A negative gallium positron emission tomography along with normal urinary metanephrines levels ruled out the diagnosis of pheochromocytoma. During the hospital stay, the patient experienced new episodes of chest pain, followed by two episodes of in-hospital cardiac arrest successfully resuscitated. The ECG showed transient ST-segment elevation in the anterior and lateral leads. Emergency CA revealed severe dynamic vasospasm at the ostium and proximal segments of the left anterior descending artery and circumflex artery, that regressed after intracoronary nitroglycerine. Therapy with both non-dihydropyridine and dihydropyridine calcium channel blockers, alongside nitrates, was initiated. Reviewing the patient's medical history revealed that he had been consuming at least 3 L of cola daily at home. Approximately 1 h before his last two cardiac arrests, he drank another can of cola. Before discharge, he received a dual-chamber defibrillator for secondary prevention.
Life-threatening arrhythmias and recurrent cardiac arrest are rare but severe potential consequences of CAS, particularly in the presence of synergistic triggers such as caffeine and cannabinoids. Lifestyle modification and targeted pharmacotherapy in high-risk CAS patients may not be sufficient to prevent life-threatening complications.
冠状动脉痉挛（CAS）是冠状动脉的一种暂时性严重狭窄，通常表现为静息时对硝酸盐敏感的心绞痛、短暂性缺血性心电图改变，在某些情况下会导致无症状性心肌缺血、急性心肌梗死、危及生命的心律失常和心脏骤停。
一名47岁男性，有慢性冠状动脉综合征病史，初步诊断可能为嗜铬细胞瘤，在两次院外心脏骤停成功复苏后被收入急诊科。观察到短暂性ST段抬高，急诊冠状动脉造影（CA）显示无明显冠状动脉狭窄。他的病史还包括既往酗酒和持续使用大麻。镓正电子发射断层扫描结果为阴性，同时尿间甲肾上腺素水平正常，排除了嗜铬细胞瘤的诊断。住院期间，患者出现新的胸痛发作，随后两次院内心脏骤停成功复苏。心电图显示前壁和侧壁导联短暂性ST段抬高。急诊CA显示左前降支动脉和回旋支动脉开口及近端节段严重动态血管痉挛，冠状动脉内注射硝酸甘油后缓解。开始使用非二氢吡啶类和二氢吡啶类钙通道阻滞剂以及硝酸盐进行治疗。回顾患者病史发现，他在家中每天至少饮用3升可乐。在他最后两次心脏骤停前约1小时，他又喝了一罐可乐。出院前，他接受了双腔除颤器用于二级预防。
危及生命的心律失常和反复心脏骤停是CAS罕见但严重的潜在后果，尤其是在存在咖啡因和大麻等协同触发因素的情况下。对于高危CAS患者，改变生活方式和针对性药物治疗可能不足以预防危及生命的并发症。
