Management of cardiac arrest caused by coronary artery spasm: Epinephrine/adrenaline versus nitrates

Kiss, G.; Corre, Olivier Le; Guéret, Gildas; Ba, Vinh Nguyen; Gilard, Martine; Boschat, J.; Arvieux, C. C.

doi:10.1016/j.hrtlng.2008.04.005

Cited by 11 publications

(5 citation statements)

References 25 publications

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“…hence, calcium antagonists and/or nitrates have been reported as the recommended treatment [12,26]. However, we could not confirm that the cause of cardiac arrest in this case was cardiovascular spasm caused by iohexol administration.…”

contrasting

confidence: 55%

ST segment depression and ventricular fibrillation in a dog after contrast agent administration

Tamogi

Itami

Hori

et al. 2020

The Journal of Veterinary Medical Science

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An 11-year-old Toy Poodle underwent a computed tomography examination with contrast (iohexol) enhancement under anesthesia. Heart rate and R-wave amplitude on electrocardiogram (ECG) increased 2.5 minutes after iohexol administration, and end-tidal carbon dioxide decreased to 12 mmHg. A progressive ST segment depression was observed on ECG. Subsequently, the ECG waveform changed to ventricular fibrillation. However, spontaneous circulation returned following cardiopulmonary resuscitation. Myocardial ischemia or anaphylactic shock was suspected in the dog, which explains the ST segment depression observed on ECG. When performing radiological examinations with a contrast agent, the ECG waveform changes, such as an increase in heart rate, R-wave amplitude, or ST segment depression, should be carefully monitored. This might enable early detection of cardiac dysfunction and the ensuing cardiac arrest in dogs.

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contrasting

confidence: 55%

ST segment depression and ventricular fibrillation in a dog after contrast agent administration

Tamogi

Itami

Hori

et al. 2020

The Journal of Veterinary Medical Science

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“…Management of cardiac arrest: Some case reports have described the use of nitrates during VA-induced cardiac arrest with successful outcome by avoiding adrenaline 9 , 10 . In our patient, we, however, gave adrenaline during CPR and did not find it detrimental.…”

Section: Discussionmentioning

confidence: 58%

Variant angina in chronic kidney disease: a case report of an unusual presentation of cardiac arrest following dialysis

Mishra

Roguin²

2017

European Heart Journal - Case Reports

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Variant angina (VA) is described as a relatively benign syndrome of unprovoked chest pain and electrocardiographic (ECG) changes. Chronic kidney disease (CKD) may be associated with this syndrome. However, the incidence of severe manifestations of VA in this patient cohort with kidney disease has not been elucidated. Also, no description has been made of coronary vasospam in relation to dialysis sessions. Our patient, a young female with CKD, had an unusual history of angina following dialysis sessions and she suffered an acute coronary syndrome complicated by cardiac arrest. The diagnosis was made on the basis of her clinical features, dynamic ECG changes, and coronary angiogram findings, and the patient was managed medically. Severe manifestations of VA may occur in chronic kidney disease, and this should be kept in mind by the treating physician. The association of coronary vasospasm with dialysis needs further analysis.

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“…The 2015 American Heart Association guideline for cardiopulmonary resuscitation recommends using nitroglycerine during the resuscitation of patients with cocaine-induced vasospasm but does not explicitly address patients with VA. Nevertheless nitroglycerin has been successfully used in the resuscitation of patients with VA, as was the case in this patient.…”

Section: Discussionmentioning

confidence: 69%

A Young Woman With Refractory Vasospastic Angina

2019

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A woman in her early 30s with a history of mild bronchial asthma and nasal polyps presented to the emergency department with chest pain, electrocardiographic ST elevation, and sudden cardiac arrest. Cardiopulmonary resuscitation was initiated and was followed with coronary angiography, which showed significant 3-vessel stenosis that completely resolved after nitroglycerin injection. The patient was diagnosed as having vasospastic angina (VA); diltiazem and glyceryl trinitrate were prescribed, and an implantable cardioverter-defibrillator (ICD) was implanted.Two months later, she presented with similar symptoms to another hospital; her ICD had not delivered a shock. Because she was not carrying her medical records, she was immediately transferred to the catheterization laboratory. Angiography was again performed and showed severe spasm of all coronary vessels that resolved after nitroglycerin administration (Figure). Medical treatment was intensified by adding verapamil and a statin to the regimen.Four months later, the patient was admitted to our center in an unconscious state. The electrocardiogram showed asystole with pacemaker spikes not followed by QRS complexes. Cardiopulmonary resuscitation was started, but after 10 minutes of resuscitation there was no response. Given her history of VA, we started nitroglycerin infusion, which resulted in return to normal sinus rhythm after 5 minutes with a palpable peripheral pulse.Despite the intensification of therapy with isosorbide mononitrate and concomitant use of amlodipine, diltiazem, and benzodiazepine, the patient experienced another episode of asystole and multiple episodes of asymptomatic ST-T changes in the coronary care unit. Her ejection fraction declined to 30%. Coronary arteries during cardiac A Coronary arteries after nitroglycerin administration B Figure. Total occlusion of all coronary arteries during cardiac arrest (A) that was completely resolved after nitroglycerin administration (B).

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Management of cardiac arrest caused by coronary artery spasm: Epinephrine/adrenaline versus nitrates

Cited by 11 publications

References 25 publications

ST segment depression and ventricular fibrillation in a dog after contrast agent administration

ST segment depression and ventricular fibrillation in a dog after contrast agent administration

Variant angina in chronic kidney disease: a case report of an unusual presentation of cardiac arrest following dialysis

A Young Woman With Refractory Vasospastic Angina

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