Vasopressor-Induced Generalized Coronary Vasospasm Presenting as Inferior ST-Segment Elevation in Post-Cardiopulmonary Resuscitation

Abstract

This case describes a 47-year-old man with a history of malignant hypertension and end-stage renal disease who had an in-hospital cardiac arrest…

ST-Segment Elevation Myocardial Infarction on the Line: Inadvertent Arterial Infusion of Vasopressors Causing Acute Myocardial Infarction

“… 8 , 9 For example, post–return of spontaneous circulation ST-segment elevation was reported following vasopressor infusion in a patient without underlying obstructive coronary artery disease. 9 - 11 The excessive catecholamine infusion stimulates vasospasm causing widespread ischemia of the affected arteries. Our patient developed STEMI following accidental cannulation and infusion of vasopressors through the coronary ostia.…”

Are Vasopressors an Enemy of the Coronary Arteries?

“…Elkaryoni et al. (3) quickly realized the cause of the coronary narrowing and administered appropriate treatment, confirming the diagnosis of coronary spasm. The case serves to highlight the importance of context in the interpretation of ECG findings.…”

“…Coronary spasm is more frequently associated with selective α-adrenergic agents such as ephedrine or phenylephrine (5) . In the current case (3) , the patient was receiving substantial doses of all these drugs, which were carefully down-titrated after diagnosing coronary spasm. Additionally, the patient was described as suffering from malignant hypertension and end-stage renal impairment.…”

“…In this issue of JACC: Case Reports, Elkaryoni et al. (3) present the case of a complex medical patient who developed new electrocardiographic (ECG) changes mimicking inferior ST-segment elevation myocardial infarction several hours following an in-hospital cardiac arrest, probably due to iatrogenic coronary spasm. The suggested hypothesis for the ECG changes was the introduction of inotropic and vasopressor agents to treat hypotension after cardiac arrest.…”