심정지를 수반한 다중 관상동맥 연축 1예

A case of three-vessel coronary artery spasm presenting with aborted sudden cardiac death

변이협심증 환자가 가슴통증으로 내원 후 발생한 심정지로, 심폐소생술 및 관상동맥조영술을 시행하여 세 관상동맥 모두의 전반적 연축을 발견하였고, 관상동맥 내 nitroglycerin 투여로 호전되었다. 재연축을 방지하기 위해 지속적인 정맥 내 질산염제제를 투여하였으나, 두 차례의 ST분절 상승을 포함한 심전도 변화와 심정지가 있었고, 설하 nifedipine으로 혈압과 심전도의 이상을 교정할 수 있었다. 환자의 급성 심정지에 관련된 요인으로 다혈관 연축 즉, 3개의 관상동맥 모두의 협착과 약물의 일시 중단이 중요한 인자라고 생각된다. 이와 같이 급사와 관련된 불량 예후가 예측되는 환자에서 보다 장기적으로 지속적이고 충분한 약물치료 및 철저한 교육이 필요하겠다.

A 51-year-old female patient was referred to the emergency department with a 5-h history of resting chest pain. The patient, who had been diagnosed with variant angina six months previously, had not used her medications within two days of presentation. Electrocardiography (ECG) revealed a T wave inversion on lead I, AVL, and all precordial leads. Two hours later, the patient's chest pain was suddenly aggravated with an ST segment elevation noted from leads V2-6, leading to shock. Emergency management, including cardiopulmonary resuscitation (CPR), was initiated. Coronary angiography showed diffuse multifocal narrowing of three vessels; however, the vessels recovered following the intracoronary injection of nitroglycerin. The patient went into cardiac arrest two more times during continuous nitroglycerin infusion. The attacks were managed using CPR and sublingual nifedipine. Here, we describe a rare case of life-threatening three-vessel coronary vasospasm and its successful management with calcium channel blockers.