Refractory vasospasms of the coronary arteries due to multiple factors: an autopsy case.
A 41-year-old man was admitted with decompensated heart failure. Mechanical ventilation was maintained with a large dose of propofol. On day 4, significant ST elevation with complete atrioventricular block was noted, which subsequently induced cardiopulmonary arrest. Treatment with percutaneous cardiopulmonary support and therapeutic hypothermia was initiated. Emergent cardiac angiography showed simultaneous multivessel coronary spasms. Although nitroglycerin and nicorandil were ineffective, the intracoronary administration of fasudil, a Rho-kinase inhibitor, successfully resolved the vasospasms. However, during rewarming, the coronary vasospasms recurred, and the patient died of cardiogenic shock. In addition to hypertrophy, the autopsied heart demonstrated the accumulation of inflammatory cells in the pericardium and adventitia of the coronary arteries.
Division of Cardiology, Fujisawa City Hospital, Japan.
Kentaro
K
Arakawa
Hideo
H
Himeno
Toshikazu
T
Gondo
Jin
J
Kirigaya
Fumie
F
Otomo
Kensuke
K
Matsushita
Hidefumi
H
Nakahashi
Satoru
S
Shimizu
Manabu
M
Nitta
Hideto
H
Yano
Mitsuaki
M
Endo
Kazuo
K
Kimura
Satoshi
S
Umemura
D000328:Adult; D001344:Autopsy; D003329:Coronary Vasospasm / Q000209:etiology / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology*; D003937:Diagnosis, Differential; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects*; D008297:Male