Tekrarlayan Kardiyak Arrest ve Ventriküler Fibrilasyon ile Prezente Olan Rekürren Vazospastik Anjina

Abstract

Giriş: Vazospastik anjina (VSA), geçici koroner vazospazm ile karakterize, potansiyel olarak ölümcül bir miyokardiyal iskemi nedenidir. Genellikle yönetilebilir olmakla birlikte, hayatı tehdit eden ventriküler aritmiler ve kardiyak arreste yol açabilir. Olgu Sunumu: 45 yaşında kadın hasta, 15 aylık sürede üç kardiyak arrest epizodu yaşadı. Her olayda EKG'de ST yükselmesi ve anjiyografik olarak doğrulanan, intrakoroner nitrogliserin ile düzelen kritik çok damarlı vazospazm (LMCA, LAD, LCx) mevcuttu. Başlangıçta uygulanan diltiazem ve nitrat tedavisi, ilaç uyumsuzluğunun da katkısıyla nüksleri önleyemedi. İkinci arrest sonrası implante edilen implante edilebilir kardiyoverter-defibrilatör (ICD) şok vererek devreye girdi. Üçüncü arrestin ardından düşük sol ventrikül ejeksiyon fraksiyonu (LVEF: %35-40) nedeniyle diltiazem nebivolole (5 mg/gün) değiştirildi; izosorbid mononitrat (40 mg/gün) ise nitratsız aralık uygulanarak sürdürüldü. Beş aylık takipte hasta bu rejimle semptomsuz kalmıştır. Sonuç: Bu olgu, refrakter ventriküler aritmiler ve tekrarlayan arrest dahil VSA'nın yaşamı tehdit eden potansiyelini ortaya koymaktadır. Yüksek riskli hastalarda sürekli tedaviye uyum ve ICD'nin kritik rolünü vurgulamaktadır.

Keywords

• Vazospastik anjin
• Prinzmetal anjini
• Koroner vazospazm
• Kardiyak arrest
• İntrakoroner nitrat
• İlaç uyumu

Recurrent Vasospastic Angina Presenting as Recurrent Cardiac Arrest and Ventricular Fibrillation

Abstract

Introduction: Vasospastic angina (VSA) is a potentially lethal cause of myocardial ischemia characterized by transient coronary vasospasm. While typically manageable, it can provoke life-threatening ventricular arrhythmias and cardiac arrest. Case Presentation: A 45-year-old woman experienced three cardiac arrests over 15 months. Each event featured ST-elevation on ECG and critical multi-vessel spasm (LMCA, LAD, LCx) confirmed angiographically, resolving with intracoronary nitroglycerin. Initial treatment with diltiazem and nitrates failed to prevent recurrences, complicated by medication non-adherence. An ICD implanted after the second arrest delivered shocks. After the third arrest, reduced LVEF (35-40%) necessitated switching from diltiazem to nebivolol (5 mg/day), while isosorbide mononitrate (40 mg/day) was continued with a nitrate-free interval. At 5-month follow-up, the patient remained symptom-free on this regimen. Conclusion: This case illustrates VSA’s life-threatening potential, including refractory ventricular arrhythmias and recurrent arrest. It underscores the critical role of sustained pharmacotherapy adherence and ICDs in high-risk patients.

Keywords

• Vasospastic angina
• Prinzmetal angina
• Coronary vasospasm
• Cardiac arrest
• Intracoronary nitrate
• Medication adherence

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