Recurrent Ventricular Fibrillation Due to Coronary Vasospasm Without Preceding ST-Segment Elevation or Chest Pain.

Jeremy William, Luigi Zanetti Ferreira, Aleksandr Voskoboinik, David Chieng, Justin A Mariani, Hitesh Patel

Abstract readCase Reports

In one paragraph

Article in JACC. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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6 authors.

Jeremy WilliamThe Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia.

Luigi Zanetti FerreiraMonash University, Melbourne, Victoria, Australia.

Aleksandr VoskoboinikThe Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia.

David ChiengThe Alfred Hospital, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.

Justin A MarianiThe Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia.

Hitesh PatelThe Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia. Electronic address: h.patel@alfred.org.au.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCoronary vasospasm (CV) is a rare cause of malignant ventricular arrhythmia and cardiac arrest. It typically presents with chest pain and marked ST-segment elevation. CASE SUMMARY: We present the case of a 61-year-old man with recurrent malignant ventricular arrhythmia and implantable defibrillator shocks without preceding chest pain. The diagnosis of CV remained elusive for 3 months despite extensive investigation. Close inspection of telemetry revealed progressive ST-segment depression and T-wave inversion before arrest. Coronary angiography with low-dose acetylcholine testing revealed multivessel vasospasm. Vasodilator therapy was initiated with rapid elimination of ventricular arrhythmia. DISCUSSION: This case highlights that cardiac arrest due to CV may present without the classical features of chest pain or ST-segment elevation, underscoring the value of provocation testing in unexplained arrhythmia. TAKE-HOME MESSAGES: CV may present without preceding angina or ST-segment elevation. Careful electrocardiogram review and early provocation testing can identify vasospasm and guide therapy.

Indexed as

acetylcholine provocation testcoronary vasospasmimplantable cardioverter defibrillatorvasodilator therapyventricular fibrillation

Identifiers

PMID40750176

DOI10.1016/j.jaccas.2025.104157

PMCPMC12441568

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