A Case Report on Variant Angina with Ventricular Fibrillation during Relief from Angina Attack

The report describes a 64-year-old man with frequent early morning precordial pain. In December 1980, he began to have episodes of dull pain in the substernal region early in the morning. On admission in July 1982, the patient's blood pressure was 120/84 mm Hg, and his pulse was 63 bpm and regular. Significant abnormalities were not noted in the physical examination, and the blood chemistry was the normal range. During a chest pain attack on the second hospitalization day, ST segment elevation was recorded at II, III and aV_F, and isosorbide dinitrate was administered sublingually. The patient then developed a ventricular fibrillation (VF) as the ST segment had began to decrease. A direct current shock was used immediately and the VF resolved. A significant stenosis of coronary artery was not present on the coronary angiography. The arrhythmia during the decrease in the ST segment may be explained as a so-called reperfusion arrhythmia. Thus, prevention of coronary spasm by calcium antagonists and/or long-acting nitrates appears important.