Grewal D, Mohammad A, Swamy P, Abudayyeh I, Mamas MA, Parwani P. Diffuse coronary artery vasospasm in a patient with subarachnoid hemorrhage: A case report. World J Cardiol 2020; 12(9): 468-474 [PMID: 33014294 DOI: 10.4330/wjc.v12.i9.468]
Corresponding Author of This Article
Purvi Parwani, FACC, MBBS, Assistant Professor, Division of Cardiology, Department of Cardiology, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354, United States. pparwani@llu.edu
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Sep 26, 2020; 12(9): 468-474 Published online Sep 26, 2020. doi: 10.4330/wjc.v12.i9.468
Diffuse coronary artery vasospasm in a patient with subarachnoid hemorrhage: A case report
Dennis Grewal, Adeba Mohammad, Pooja Swamy, Islam Abudayyeh, Mamas A Mamas, Purvi Parwani
Dennis Grewal, Adeba Mohammad, Pooja Swamy, Islam Abudayyeh, Purvi Parwani, Division of Cardiology, Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
Mamas A Mamas, Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Stoke on Trent, Manchester M139PT, United Kingdom
Author contributions: Grewal D provided references for and wrote the majority of the introduction, discussion and conclusion sections and provided the figures; Mohammad A wrote the majority of the case presentation, acquired necessary documentation for submission and completed final formatting of submission documents; Swamy P performed the initial evaluation of the patient and assisted with the coronary catheterization; Abudayyeh I performed the coronary angiogram and provided the coronary catheterization films and still images; Swamy P, Abudayyeh I and Mamas MA contributed towards revising the manuscript critically for important intellectual content; Parwani P handled supervision, made substantial contribution to the conception of the paper, drafted the first manuscript, provided critical edits to the final manuscript in addition to providing the CMRI imaging, and is the senior and corresponding author of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised accordingly.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Purvi Parwani, FACC, MBBS, Assistant Professor, Division of Cardiology, Department of Cardiology, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354, United States. pparwani@llu.edu
Received: June 6, 2020 Peer-review started: June 6, 2020 First decision: June 20, 2020 Revised: July 3, 2020 Accepted: September 15, 2020 Article in press: September 15, 2020 Published online: September 26, 2020 Processing time: 106 Days and 11.8 Hours
Abstract
BACKGROUND
Coronary artery vasospasm (CAV) is a reversible, transient form of vasoconstriction with clinical manifestations ranging from stable angina to acute coronary syndromes (ACS). Vasospasm of epicardial coronary arteries or associated micro-vasculature can lead to total or subtotal occlusion and has been demonstrated in nearly 50% of patients undergoing angiography for suspected ACS. The mechanism for CAV has been described in literature, but in a subgroup of patients presenting with intracranial hemorrhage, it appears to be multifactorial. These patients tend to have electrocardiographic changes, elevation of cardiac biomarkers of injury and neurogenic stress cardiomyopathy.
CASE SUMMARY
A 44-year-old woman presented with severe headaches and tonic-clonic seizures. She was found to have diffuse subarachnoid hemorrhage (SAH) requiring ventricular drain placement, coil embolization and induced hypertension. She subsequently developed chest pain with ST elevations in anterior precordial leads, elevated cardiac enzymes and apical ballooning with left ventricular ejection fraction of 35% on transthoracic echocardiogram. Coronary angiogram revealed severe diffuse triple vessel stenoses secondary to CAV seen distally. Subsequent cardiac MRI notable for apical non-viability and scar formation.
CONCLUSION
This case highlights a unique etiology of acute myocardial infarction in a patient with SAH leading to ST elevations, diffuse triple vessel CAV and apical scar.
Core Tip: Acute coronary syndromes often occur in patients with multiple co-morbidities and treatment plans need to be tailored to each unique presentation. We present a case of ST-elevation myocardial infarction in a patient with aneurysmal subarachnoid hemorrhage complicated by cerebral and coronary vasospasms, leading to apical infarct.
