Right coronary artery spasm, QRS-ST-T “shark fin” pattern, and sudden
cardiac death. A case report.
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.