Images in Clinical Medicine

Coronary Spasm

Michael Geist, M.D., and Daniel Tarchitzky, M.D.

N Engl J Med 2002; 346:579February 21, 2002

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Figure 1 A 60-year-old man who was taking no medications was resuscitated after out-of-hospital cardiac arrest. He was found in ventricular fibrillation and underwent successful DC cardioversion. Electrocardiography documented short periods of polymorphic ventricular tachycardia and ST elevation of leads II and III as well as atrial fibrillation, which quickly reverted to sinus rhythm (Panel A). Echocardiography documented normal heart function, and there was no evidence of a myocardial infarction. Coronary angiography revealed normal coronary arteries. During the injection of dye to the dominant right coronary artery, severe coronary spasm developed, which was not induced by the catheter. The spasm started midway through the artery (Panels B and C) and was associated with ST-segment elevation. The spasm resolved with intracoronary nitrates (Panel D). The right coronary artery is a common site of isolated coronary-artery spasm leading to cardiac arrest. The patient was treated with verapamil and nitrates and underwent implantation of a cardioverter–defibrillator. Seven months later, he had made a complete recovery and had resumed his normal activities.

Michael Geist, M.D.
Daniel Tarchitzky, M.D.
Edith Wolfson Hospital, Holon 58100, Israel

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