Coronary artery spasm following intravenous phenylephrine on a patient under general anesthesia with previously undiagnosed variant angina and successful treatment by nitroglycerin: A case report

Kim, Young Lok; Kim, Eun Ju; Seo, Da Mi; Lee, Ji Hyang; Lee, Sang Gon; Ban, Jong Seouk

Case Report

Cardiothoracic and Vascular Anesthesia

Anesthesia and Pain Medicine 2013;8(2):99-103.
Published online April 30, 2013.

Coronary artery spasm following intravenous phenylephrine on a patient under general anesthesia with previously undiagnosed variant angina and successful treatment by nitroglycerin: A case report

Young Lok Kim, Eun Ju Kim, Da Mi Seo, Ji Hyang Lee, Sang Gon Lee, Jong Seouk Ban

Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea. kej1127@fatima.or.kr

Abstract

Coronary artery spasm under general anesthesia induces interruption of blood flow of coronary arteries and can be detected by a sudden ST elevation on electrocardiogram, which may be followed by severe cardiovascular complications. We have experienced a case of a sudden ST elevation on a 52-year-old patient with no history of coronary artery diseases undergoing spine surgery under general anesthesia. Following administration of nitroglycerin, ST elevation returned to normal. Postoperative coronary angiogram showed positive on ergonovine provocation test and the patient was diagnosed as variant angina. Correlating with the results, we concluded that the ST elevation was probably due to coronary artery spasm. Although the definite mechanism of the coronary artery spasm is unclear. A-adrenergic stimulation by phenylephrine may have acted as a solitary factor or as one of many factors. Early administration of nitroglycerin and calcium channel blocker seems to be useful in treatment and prevention of recurrence.

Key Words: Coronary artery spasm, Nitroglycerin, Phenylephrine, ST elevation, Variant angina