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Polymorphic ventricular tachycardia due to Prinzmetal angina. A case report

Elena Sotirova, Maria Vetkova, Dani Atanasov, Petranka Encheva, Atanas Angelov

Abstract

Introduction: Prinzmetal angina, or vasospastic angina, is a rare kind of angina, representing about two out of a hundred cases. It is frequently associated with coronary artery disease (CAD) and pa­tients with normal coronary arteries are rare. The angina is caused by a vasospasm of the coronary arteries, which dramatically reduces the coronary blood flow. This usually leads to transmural myo­cardial ischemia, typically manifested by ST segment elevation on the electrocardiogram (ECG). Pa­tients with vasospastic angina and normal coronary arteries have good prognosis, but when associ­ated with CAD there is a risk of life-threatening ventricular arrhythmias and sudden cardiac death (SCD). The purpose of this report is to present a rare clinical case of Prinzmetal angina resulting in polymorphic ventricular tachycardia (PVT).

Materials and methods: A case of a 76-year-old man with a history of CAD, chronic ventricular ec­topics Lown class V, six days after successful percutaneous coronary intervention (PCI) is present­ed. The patient presented with a new onset of angina in rest, followed by syncope. Standard ECG at admission didn`t show ischemic ST-T changes. Monitoring and Holter ECG revealed recurrent epi­sodes of transient ST elevations, followed by non-sustained PVT, during which the patient suffered angina and dizziness.

Results: This was considered to be a case of vasospastic angina, associated with life threatening ven­tricular arrhythmias. Antiarrhythmic therapy with Amiodarone and optimal anti-ischemic thera­py with vasodilators was started. Three days later, the patient suffered an episode of sustained ven­tricular tachycardia, degenerating into ventricular fibrillations, terminated with external defibrilla­tion. Automatic implantable cardioverter defibrillator (AICD) was implanted for secondary preven­tion of SCD.

Conclusion: Prinzmetal angina is a rare kind of angina, frequently associated with CAD, life-threat­ening arrhythmias and risk of SCD. Secondary prevention with AICD implantation and optimal an­ti-ischemic therapy is indicated.


Keywords

Prinzmetal angina; ventricular tachycardia; cardioverter defibrillator




DOI: http://dx.doi.org/10.14748/ssvs.v2i0.4691

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