Recurrent Cardiac Arrests from Pulseless Electrical Activity Linked to Coronary Vasospasm in the Absence of Obstructive Coronary Artery Disease

July 7, 2026

Annals Of Internal Medicine: Clinical Cases

Objective:

To highlight a case of recurrent pulseless electrical activity arrests caused by coronary vasospasm in a postoperative patient, emphasizing its underrecognized nature.

Approach:

Case Presentation: A 68-year-old man with a complex medical history, including hypertension and cirrhosis, presented with severe abdominal pain and underwent emergent surgery for a perforated pyloric ulcer. Postoperatively, he experienced recurrent PEA arrests.

Key Findings:

Coronary vasospasm can mimic acute coronary syndromes and lead to life-threatening cardiac instability.
Transient ischemic ECG changes and absence of obstructive coronary disease are critical indicators for diagnosing vasospasm.
Rapid response to vasodilators can prevent irreversible myocardial injury.

Interpretation:

The case highlights the importance of early suspicion of coronary vasospasm in critically ill patients, particularly when standard diagnostic methods are limited.

Limitations:

Invasive coronary functional testing was not performed due to the patient's unstable condition, which may have affected the diagnostic accuracy.
Diagnosis relied on clinical pattern recognition rather than definitive testing.