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.