title: A case of intraoperative coronary artery spasm in a patient with vascular disease.
abstract: A 66-year-old man with a history of longtime smoking, untreated hypertension, hyperlipidemia, and impaired glucose tolerance but no history of myocardial infarction or angina pectoris was scheduled for right aortofemoral bypass and thromboembolectomy for arteriosclerosis obliterans with right common iliac and right popliteal arterial thrombus. Epidural anesthesia and general anesthesia were administered without obvious ECG changes. Just after skin incision, ST elevation in leads II and V5 and a short run of ventricular tachycardia with frequent premature ventricular contractions (PVCs) were recorded on the ECG monitor, and the patient's blood pressure suddenly decreased within a few seconds. On noticing these changes, we suspected coronary artery spasm (CAS) and rapidly administered vasodilators and vasopressors to stabilize hemodynamics and ECG changes. Transesophageal echocardiography (TEE) showed basal to mid- and anteroseptal to inferior wall motion hypokinesis that gradually returned to normal during observation. Even in patients without coronary disease but with systemic arteriosclerosis, it is important to consider the possibility of perioperative CAS and not to overlook ECG changes. Immediate diagnosis and treatment are essential.
authors.affiliation: Department of Anesthesiology, Nagano Matsushiro General Hospital, 183 Matsushiro, Matsushiro town, Nagano, Nagano 381-1231, Japan. masaki1104@hotmail.com
authors.forename: Masaki
authors.initials: M
authors.lastname: Ito
authors.forename: Masachika
authors.initials: M
authors.lastname: Hayashi
authors.forename: Shin
authors.initials: S
authors.lastname: Kagaya
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kitoh
authors.forename: Sohtaro
authors.initials: S
authors.lastname: Miyoshi
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D001162:Arteriosclerosis Obliterans / Q000150:complications* / Q000601:surgery*; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000209:etiology / Q000628:therapy*; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D008297:Male; D016343:Monitoring, Intraoperative; D017202:Myocardial Ischemia / Q000517:prevention & control; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents