Reversible Coronary Spasm Induced by Marcaine Mimicking Non-ST Segment Elevation Myocardial Infarction in a Young Patient: A Case Report
Asian Journal of Cardiology Research,
Page 17-22
Abstract
Bupivacaine (marcaine) is a long-acting local anesthetic used for skin infiltration, peripheral nerve blocks, epidural and spinal anesthesia. Its application can lead to cardiovascular complications such as: hypotension, bradycardia, cardiac arrest and toxic myocardial injury. Few cases of coronary artery spasm induced by bupivacaine mimicking myocardial infection have been reported in the literature. We report a case of a reversible coronary spasm induced by marcaine during spinal anesthesia confirmed by a provocative vasoactive test on coronary angiography in a 38-year young patient without a known cardiovascular disease admitted initially for scheduled fissurectomy and hemorrhoidectomy in whom treatment by calcium channel blockers reversed patient’s symptoms and electrophysiology signs.
Keywords:
- Spinal anesthesia
- coronary spasm
- myocardial infarction
How to Cite
Njie, M., Jazouli, A. E., Mulendelé, P. M., Charfo, M., Haboub, M., Salim, A., Benouna, M. G., Drighil, A., Azzouzi, L., & Habbal, R. (2022). Reversible Coronary Spasm Induced by Marcaine Mimicking Non-ST Segment Elevation Myocardial Infarction in a Young Patient: A Case Report. Asian Journal of Cardiology Research, 7(1), 17-22. Retrieved from https://journalajcr.com/index.php/AJCR/article/view/30193
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Tern S, Bayes de Luna A. Coronary artery spasm: A 2009 update. Circulation. 2009;119:2531 – 4.
Ho Yoel Ryu, Jang Young Kim,Hyun Kyo Lim, Junghan Yoon, Byung-su Yoo, Kyung-Hoon Choe and Seung-Hwan Lee. Bupivacaine induced cardiac toxicity mimicking and acute non-ST segment elevation Myocardial Infarction. Yonsei Medical Journal. 2007;48:331-336.
Kasuya Y, Okumura Y, Tanabe K, Suzuki A. A case of cardiac arrest with coronary artery spasm during lumbar epidural anesthesia.
Available: https://pubmed.ncbi.nlm.nih.gov/11244779/
Moller R, Covino BG, Cardiac electrophysiologic properties of bupivacaine and Lidocaine compared with those of ropivacaine, a new amide local anesthesia. Anesthesiology. 1990;73: 322-9.
Feldman HS, Arthur GR, Pikanen M, Hurley R, Doucette AM, Covino BG. Treatment of acute systemic toxicity after the rapid intravenous injection of ropivacaine ad bupivacaine in the conscious dog. Anesth Analg. 1991;73: 373-84.
Coven G, Arpesella R, Ciceri M, Preseglio I, Cardani A. Accelerated idioventricular rthythm during spinal anesthesia for cesarean section. Int J Obstet Anesth. 2003;12:121-5.
Cotileas P, Myrianthefs P, Haralambakis A, Cotsopoulos P, Stamatopoulon C, Ladakis C, et al. Bupivacaine-induced myocardial depression and pulmonary edema. A case report J Electrocardiol. 2000;33:291-6.
Giancarlo Pirozzolo, Valeria Martínez Pereyra, Astrid Hubert, Fabian Guenther, Udo Sechtem, Raffi Bekeredjian, Heiko Mahrholdt, Peter Ong, Andreas Seitz .Coronary artery spasm and impaired myocardial perfusion in patients with ANOCA: Predictors from a multimodality study using stress CMR and acetylcholine testing Int J Cardiol. 2021;343:5-11.
Ong P, Athanasiadis A, Hill S, Vogelsberg H, Voehringer M, Sechtem U. Coronary artery spasm as a frequent cause of acute coronary syndrome: Th e CASPAR (coronary artery spasm in patients with acute coronary syndrome) study. J Am Coll Cardiol. 2008;52:523 – 7.
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Acikel S, Dogan M, Sari M, Kilic H, Akdemir R. Prinzmetal. Variant angina in a patient using zolmitriptan and citalopram. AmJ Emerg Med. 2010;28:257. 3 – 6.
Sueda S, Kohno H, Fukuda H, Ochi N, Kawada H, Hayashi Y, et al. Clinical impact of selective spasm provocation tests: Comparisons between acetylcholine and ergonovine in 1508 examinations. Coron Artery Dis. 2004;15:491 – 7.
Ye-Fei Li, Yu Zhang, Liang Chen, Kou-Long Zheng, Hui-He Lu, Zhen-Qiang Sheng. Diagnosis of coronary artery spasm by ergonovine provocation test of radial artery. Sci Rep. 2021;11 :3767.
Ichikawa J, Kurata J, Nishiyama K, Ozaki M. Case of coronary spasm during thoracic surgery under combined epidural-general anesthesia. Masui. 2007;56:425– 8.
Wang BS, Kim M, Kang SK, Hwang BM, Son HJ, Cheong IY. Severe hypotension caused by coronary spasm during recovery from combined spinal epidural anesthesia. Korean J Anesthesiol. 2008; 54:343 – 6.
Ornek E, Ornek D, Murat SN, Turfan M. Angiographic documentation of coronary artery spasm induced by anesthesia. J Anesth. 2010 ;24 :452 – 5.
Easley RB, Rosen RE, Lindeman KS. Coronary artery spasm during initiation of epidural anesthesia. Anesthesiology. 2003;99:1015– 7.
Mallick PN, Upadhaya SP, Das AK, Singh RK. Takotsubo cardiomyopathy mimicking postoperative myocardial infarction in a young healthy patient. Indian Journal of Anaesthesia. 2013;57:193.
Ryu HY, Kim JY, Lim HK, Yoon J, Yoo BS, Choe KH, Lee SH. Bupivacaine induced cardiac toxicity mimicking an acute non-ST segment elevation myocardial infarction. Yonsei Medical Journal. 2007;48:331-6.
Michael Mutlak & Eugenia Nikolsky. Severe coronary artery spasm induced by epidural injection of bupivacaine hydrochloride: A case report Acute Cardiac Care. 2011;13(3):155–158.
Tern S, Bayes de Luna A. Coronary artery spasm: A 2009 update. Circulation. 2009;119:2531 – 4.
Ho Yoel Ryu, Jang Young Kim,Hyun Kyo Lim, Junghan Yoon, Byung-su Yoo, Kyung-Hoon Choe and Seung-Hwan Lee. Bupivacaine induced cardiac toxicity mimicking and acute non-ST segment elevation Myocardial Infarction. Yonsei Medical Journal. 2007;48:331-336.
Kasuya Y, Okumura Y, Tanabe K, Suzuki A. A case of cardiac arrest with coronary artery spasm during lumbar epidural anesthesia.
Available: https://pubmed.ncbi.nlm.nih.gov/11244779/
Moller R, Covino BG, Cardiac electrophysiologic properties of bupivacaine and Lidocaine compared with those of ropivacaine, a new amide local anesthesia. Anesthesiology. 1990;73: 322-9.
Feldman HS, Arthur GR, Pikanen M, Hurley R, Doucette AM, Covino BG. Treatment of acute systemic toxicity after the rapid intravenous injection of ropivacaine ad bupivacaine in the conscious dog. Anesth Analg. 1991;73: 373-84.
Coven G, Arpesella R, Ciceri M, Preseglio I, Cardani A. Accelerated idioventricular rthythm during spinal anesthesia for cesarean section. Int J Obstet Anesth. 2003;12:121-5.
Cotileas P, Myrianthefs P, Haralambakis A, Cotsopoulos P, Stamatopoulon C, Ladakis C, et al. Bupivacaine-induced myocardial depression and pulmonary edema. A case report J Electrocardiol. 2000;33:291-6.
Giancarlo Pirozzolo, Valeria Martínez Pereyra, Astrid Hubert, Fabian Guenther, Udo Sechtem, Raffi Bekeredjian, Heiko Mahrholdt, Peter Ong, Andreas Seitz .Coronary artery spasm and impaired myocardial perfusion in patients with ANOCA: Predictors from a multimodality study using stress CMR and acetylcholine testing Int J Cardiol. 2021;343:5-11.
Ong P, Athanasiadis A, Hill S, Vogelsberg H, Voehringer M, Sechtem U. Coronary artery spasm as a frequent cause of acute coronary syndrome: Th e CASPAR (coronary artery spasm in patients with acute coronary syndrome) study. J Am Coll Cardiol. 2008;52:523 – 7.
Pozzati A, Pancaldi LG, Di Pasquale G, Pinelli G, Bugiardini P.Transient sympathovagal imbalance triggers “ ischemic ” sudden death in patients undergoing electrocardiographic Holter monitoring. J Am Coll Cardiol. 1996;27:847 – 52.
Acikel S, Dogan M, Sari M, Kilic H, Akdemir R. Prinzmetal. Variant angina in a patient using zolmitriptan and citalopram. AmJ Emerg Med. 2010;28:257. 3 – 6.
Sueda S, Kohno H, Fukuda H, Ochi N, Kawada H, Hayashi Y, et al. Clinical impact of selective spasm provocation tests: Comparisons between acetylcholine and ergonovine in 1508 examinations. Coron Artery Dis. 2004;15:491 – 7.
Ye-Fei Li, Yu Zhang, Liang Chen, Kou-Long Zheng, Hui-He Lu, Zhen-Qiang Sheng. Diagnosis of coronary artery spasm by ergonovine provocation test of radial artery. Sci Rep. 2021;11 :3767.
Ichikawa J, Kurata J, Nishiyama K, Ozaki M. Case of coronary spasm during thoracic surgery under combined epidural-general anesthesia. Masui. 2007;56:425– 8.
Wang BS, Kim M, Kang SK, Hwang BM, Son HJ, Cheong IY. Severe hypotension caused by coronary spasm during recovery from combined spinal epidural anesthesia. Korean J Anesthesiol. 2008; 54:343 – 6.
Ornek E, Ornek D, Murat SN, Turfan M. Angiographic documentation of coronary artery spasm induced by anesthesia. J Anesth. 2010 ;24 :452 – 5.
Easley RB, Rosen RE, Lindeman KS. Coronary artery spasm during initiation of epidural anesthesia. Anesthesiology. 2003;99:1015– 7.
Mallick PN, Upadhaya SP, Das AK, Singh RK. Takotsubo cardiomyopathy mimicking postoperative myocardial infarction in a young healthy patient. Indian Journal of Anaesthesia. 2013;57:193.
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