[A Rare Cause of Acute Coronary Occlusion with Inferior ST-Elevation Myocardial Infarction and Out of Hospital Cardiac Arrest].

HISTORY: The 59-year old female was successfully resuscitated after out of hospital cardiac arrest due to ventricular fibrillation. The ECG after return of spontaneous circulation showed elevated ST-segments in the inferior leads.

FINDINGS AND DIAGNOSIS: Acute coronary angiography confirmed a complete occlusion of the right coronary artery without collateral flow. However, a few seconds after intracoronary administration of nitroglycerin complete reperfusion was achieved without persistent relevant stenosis.

THERAPY AND COURSE: Stenting of the vessel was withheld. After controlled hypothermia and 68 h on respirator therapy the patient was extubated and showed no persistent neurological disorders. On day 6 she received an implantable cardioverter-defibrillator. Two weeks after the index event the patient could be discharged in good condition. Routine intracoronary administration of nitroglycerin before balloon dilatation or stenting is therefore highly recommended, also in the setting of acute coronary syndromes. Because of the high risk of recurrence, patients resuscitated from lethal cardiac arrhythmia, caused by coronary spasm should receive a cardioverter-defibrillator.