Intra- and postoperative myocardial ischemia without significant coronary artery stenosis.
A 73-year-old man without a history of coronary artery disease had two episodes of significant ST-segment elevation indicative of inferior myocardial ischemia during the resection of an abdominal aortic aneurysm. During the further course, sudden ST-segment elevations occurred and resolved spontaneously without preceding hemodynamic instability. The patient sustained two episodes of cardiac arrest due to ventricular fibrillation and intermittent third-degree atrioventricular block with ventricular asystole. On cardiac catheterization, coronary arteries had a right dominant pattern. The right coronary artery was entirely patent on multiple injections. Thus, right coronary artery spasm is the only possible explanation for these observations.
Kindgen-Milles
D
D
Department of Anaesthesiology, Heinrich-Heine-University Düsseldorf, Germany.
Vester
E G
EG
Müller
E E
EE
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D003329:Coronary Vasospasm / Q000150:complications*; D004562:Electrocardiography; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*