Author + information
- Received April 24, 2017
- Revision received May 8, 2017
- Accepted May 23, 2017
- Published online November 20, 2017.
- aDepartment of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
- bDepartment of Neurosurgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
- ↵∗Address for correspondence:
Dr. Kotaro Obunai, Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba 279-0001, Japan.
A 22-year-old woman was referred to our hospital with syncope following chest pain. Initial work-up with blood test, electrocardiography, and echocardiography were unremarkable. Diffusion-weighted magnetic resonance imaging showed acute-stage cerebral infarction in the right temporal to occipital regions (Figure 1A). In addition, cerebral angiography revealed steno-occlusive changes of the bilateral internal carotid artery and moyamoya vessels at the base of the brain (Figures 1B and 1C). We confirmed the diagnosis of cerebral infarction with moyamoya disease and planned on bilateral indirect revascularization surgery. However, she complained of paroxysmal chest pain every night. The day before surgery, she developed cardiac arrest with ventricular fibrillation and was resuscitated by electrical defibrillation. Electrocardiography after resuscitation showed ST-segment elevation in anterior leads. Emergent coronary angiography revealed vasospasm in left coronary artery (Figure 2A, Online Video 1). An intracoronary infusion of nitrates improved vasospasm with hemodynamic stabilization (Figure 2B, Online Video 2). Based on the diagnosis of variant angina, she was treated with calcium antagonists, nicorandil, and nitrates, which reduced the frequency of chest pain.
A few cases of variant angina with moyamoya disease have been reported (1). However, to our knowledge, this is the first case of variant angina leading to cardiac arrest in patients with moyamoya disease soon after cerebral infarction. Careful monitoring should be warranted in these patients to avoid serious complications.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 24, 2017.
- Revision received May 8, 2017.
- Accepted May 23, 2017.
- 2017 American College of Cardiology Foundation