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.
Conclusion:
Coronary vasospasm should be considered in postoperative patients presenting with recurrent cardiac arrests.
