Variant Angina Induced Life-Threatening Ventricular Arrhythmias: does Dual Calcium Channel Blocker Eliminates the Indication for Implantable Cardioverter Defibrillator?

Abstract

A 49-year-old white female tailor that works for a subcontractor at Clemenceau medical center, had in 25/10/2010, a severe substernal chest pain with left shoulder and bilateral arm pain, followed by near collapse. Nursing staff at the hospital who is very well acquainted with her, since she is an extremely gentle person, rushed and connected her to a monitor that showed a polymorphic ventricular tachycardia followed by ventricular fibrillation. Electrical cardioversion with 100 joules biphasic shockwas done and normal sinus rhythm restored.Her past medical history is significant for a similar episode one year ago. At that time she had chest pain, and contacted her cardiologist who asked her to come to the hospital for check up and to undergo an exercise stress test since she had no risk factors. She presented an hour later to emergency department with a cardiac arrest that was appropriately resuscitated. Echocardiogram, cardiac catheterization was normal.Severe vasospasm diagnosed and she was started on calcium blockers, nitrates, and antiplatelet agents and did well during the interim period. She is on Amlodipine 5 mg once daily, Molsidomine 4 mg TID and Aspirin 100 mg once daily. Family history is significant for an aunt from her father's side that died at age 22 with an unknown cause. She has no known allergies (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5 and Figure 6). The angiography showed diffuse