Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Sep 26, 2020; 12(9): 468-474
Published online Sep 26, 2020. doi: 10.4330/wjc.v12.i9.468
Diffuse coronary artery vasospasm in a patient with subarachnoid hemorrhage: A case report
Dennis Grewal, Adeba Mohammad, Pooja Swamy, Islam Abudayyeh, Mamas A Mamas, Purvi Parwani
Dennis Grewal, Adeba Mohammad, Pooja Swamy, Islam Abudayyeh, Purvi Parwani, Division of Cardiology, Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92354, United States
Mamas A Mamas, Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Stoke on Trent, Manchester M139PT, United Kingdom
Author contributions: Grewal D provided references for and wrote the majority of the introduction, discussion and conclusion sections and provided the figures; Mohammad A wrote the majority of the case presentation, acquired necessary documentation for submission and completed final formatting of submission documents; Swamy P performed the initial evaluation of the patient and assisted with the coronary catheterization; Abudayyeh I performed the coronary angiogram and provided the coronary catheterization films and still images; Swamy P, Abudayyeh I and Mamas MA contributed towards revising the manuscript critically for important intellectual content; Parwani P handled supervision, made substantial contribution to the conception of the paper, drafted the first manuscript, provided critical edits to the final manuscript in addition to providing the CMRI imaging, and is the senior and corresponding author of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised accordingly.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Purvi Parwani, FACC, MBBS, Assistant Professor, Division of Cardiology, Department of Cardiology, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354, United States.
Received: June 6, 2020
Peer-review started: June 6, 2020
First decision: June 20, 2020
Revised: July 3, 2020
Accepted: September 15, 2020
Article in press: September 15, 2020
Published online: September 26, 2020

Coronary artery vasospasm (CAV) is a reversible, transient form of vasoconstriction with clinical manifestations ranging from stable angina to acute coronary syndromes (ACS). Vasospasm of epicardial coronary arteries or associated micro-vasculature can lead to total or subtotal occlusion and has been demonstrated in nearly 50% of patients undergoing angiography for suspected ACS. The mechanism for CAV has been described in literature, but in a subgroup of patients presenting with intracranial hemorrhage, it appears to be multifactorial. These patients tend to have electrocardiographic changes, elevation of cardiac biomarkers of injury and neurogenic stress cardiomyopathy.


A 44-year-old woman presented with severe headaches and tonic-clonic seizures. She was found to have diffuse subarachnoid hemorrhage (SAH) requiring ventricular drain placement, coil embolization and induced hypertension. She subsequently developed chest pain with ST elevations in anterior precordial leads, elevated cardiac enzymes and apical ballooning with left ventricular ejection fraction of 35% on transthoracic echocardiogram. Coronary angiogram revealed severe diffuse triple vessel stenoses secondary to CAV seen distally. Subsequent cardiac MRI notable for apical non-viability and scar formation.


This case highlights a unique etiology of acute myocardial infarction in a patient with SAH leading to ST elevations, diffuse triple vessel CAV and apical scar.

Keywords: ST-elevation myocardial infarction, Acute coronary syndrome, Stress induced cardiomyopathy, Coronary artery vasospasm, Cerebral vasospasm, Subarachnoid hemorrhage, Case report

Core Tip: Acute coronary syndromes often occur in patients with multiple co-morbidities and treatment plans need to be tailored to each unique presentation. We present a case of ST-elevation myocardial infarction in a patient with aneurysmal subarachnoid hemorrhage complicated by cerebral and coronary vasospasms, leading to apical infarct.