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Right coronary artery spasm, QRS-ST-T “shark fin” pattern, and sudden cardiac death. A case report.
  • Anthony Kechichian,
  • Antoine Sarkis
Anthony Kechichian
Hôtel-Dieu de France
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Antoine Sarkis
Hotel-Dieu De France
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Abstract

Malignant ventricular arrhythmic storm and sudden cardiac death (SCD) following coronary vasospasm (CVS) are relatively uncommon. On another note, a specific pattern, the QRS-ST-T “shark fin” pattern on ECG, is known to be a high-risk pattern and is associated with a very poor prognosis in the context of coronary artery occlusion. Data reporting the association of CVS-induced SCD and specific high-risk ECG patterns is scant. Herein we present a case of a patient with right coronary artery (RCA) spasm who presented in sudden cardiac death and a “shark fin” pattern on ECG. Primary stenting of the residual lesion after intra-coronary nitroglycerin was performed. The patient received optimal medical therapy and an intracardiac defibrillator. Lowering the threshold for defibrillator implantation may be reasonable in CVS-induced ventricular arrhythmias particularly in the presence during vasospasm of high-risk ECG features such as the “shark fin” pattern.