Published online Jul 26, 2014. doi: 10.4330/wjc.v6.i7.685
Revised: February 20, 2014
Accepted: May 16, 2014
Published online: July 26, 2014
Processing time: 228 Days and 4 Hours
We present the case of a 65-year-old male with vasospastic angina (VSA) whose condition worsened during the perioperative period. He had been diagnosed with VSA 10 years prior. He was treated with two types of vasodilators and had not experienced any chest symptoms for 5 years. At this juncture, he underwent surgery for relapsed maxillary sublingual carcinoma. He had taken two vasodilators one day prior to surgery. Intravenous infusion of nitroglycerin (NTG) was initiated immediately before the surgery and continued the following day. Instead of stopping NTG, a dermal isosorbide dinitrate tape was applied on post-operative day 1. Two days later, a complete atrioventricular block with pulseless electrical activity appeared. After cardiopulmonary resuscitation, emergent coronary angiography showed severe coronary spasm in both the left and right coronary arteries. Intracoronary infusion of nitroglycerin and epinephrine with percutaneous cardiopulmonary support relieved the coronary spasm. During the perioperative period, several factors can trigger coronary vasospasm, including the discontinuation of vasodilators. Thus, surgeons, anesthetists, and cardiologists should watch for coronary vasospasm during this period and for worsening coronary spasm when discontinuing vasodilators in patients at risk for VSA.
Core tip: Coronary spasm during the perioperative period often emerges severely as either cardiogenic shock or ventricular fibrillation. Although there are several surgery-related factors that influence the activity of coronary spasm, discontinuing vasodilators during the perioperative period is an important problem in patients with vasospastic angina (VSA). We encountered an outpatient with VSA whose condition had been stabilized using two types of vasodilators but subsequently worsened, leading to cardiogenic shock during the perioperative period. In light of this event, physicians should carefully evaluate their patients regarding the possibility of a coronary spasm during the perioperative period.