Introduction
Prinzmetal’s angina also known as variant angina or angina inversa refers to an equivalent of the exertion angina, which frequently occurs at rest. The phenomenon was first described in 1959 by Prinzmetal et al who adopted this terminology to define the transient and significant narrowing of the coronary lumen associated with ST-segment elevation and presumably due to vasospasm1. Although various hypotheses ranging from endothelial dysfunction and primary vessel hyperreactivity to key triggering stimuli have been studied, our understanding of the pathophysiology and complications of coronary vasospasm (CVS) remain somewhat limited2. Sudden cardiac death (SCD) related to coronary spasm is probably underestimated and could account for 2% of all SCD3. On another hand, several reports have noted an association between coronary artery occlusion and some high-risk electrocardiogram (ECG) patterns4,5, such as the “shark fin” pattern also known as “giant R waves” or “triangular QRS-ST-T waveform” (TW) (Fig. 1). However, to our best knowledge, specific ECG patterns in the context of CVS-induced ventricular lethal arrhythmias have not been previously reported.
We report the case of a patient with multiple cardiovascular risk factors, presenting with SCD related to right coronary artery (RCA) spasm, preceded by a QRS-ST-T “shark fin” pattern on ECG.