Holter ECG diagnosis of nicotine-spray induced ventricular fibrillation. An unusual case of Prinzmetal variant angina

J Electrocardiol. 2020 Nov-Dec:63:17-20. doi: 10.1016/j.jelectrocard.2020.09.004. Epub 2020 Sep 24.

Abstract

We report on an interesting case of resuscitated sudden cardiac death (SDC) in a 51-year-old with hypertension and positive family history for SDC. The patient was resuscitated and an emergency angiogram ruled out coronary artery disease. Cardio-MRT ruled structural disease or infection. Holter and telemetry monitoring revealed premature ventricular complexes and transient ST-changes followed by anginaepisodes in correlation with the use of the nicotine-replacement-spray. The patient was urged to quit smoking and smoking-substitutes. Medical therapy with calcium-channelblocker and a long acting nitrate was administered. One-month follow up reported no arrhythmic or angina events.

Keywords: Case report; Clinical electrophysiology; Fibrillation; Prinzmetal variant angina; Vasospastic angina; Ventricular.

Publication types

  • Case Reports

MeSH terms

  • Angina Pectoris, Variant* / chemically induced
  • Angina Pectoris, Variant* / diagnosis
  • Electrocardiography
  • Electrocardiography, Ambulatory
  • Humans
  • Middle Aged
  • Nicotine
  • Smoking Cessation*
  • Tobacco Use Cessation Devices
  • Ventricular Fibrillation / chemically induced
  • Ventricular Fibrillation / diagnosis

Substances

  • Nicotine