Multivessel Coronary Artery Spasm

Coronary artery spasm (CAS) is a sudden, reversible narrowing of the lumen of the coronary arteries caused by spontaneous vascular smooth muscle hypercontractility. A 47-year-old woman with history of recurrent cardiac arrests presented after having a witnessed cardiac arrest requiring 3 shocks from her implantable cardioverter-defibrillator. She then suffered another cardiac arrest that resulted in hemodynamic instability requiring venoarterial extracorporeal membrane oxygenation. Coronary angiography demonstrated severe multivessel CAS that resolved with intracoronary nitroglycerin. A left stellate ganglion block was performed, and she was ultimately decannulated and discharged with a regimen of oral vasodilators. Reports of multivessel CAS leading to cardiac arrest are rare in the literature. Options for recurrent CAS refractory to medical therapy include left stellate ganglion block and sympathectomy.