Nicotine
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Ventricular fibrillation, ST-segment elevation and prinzmetal variant angina: case report A 51-year-old man developed ventricular fibrillation, ST-segment elevation and prinzmetal variant angina (PVA) during treatment with nicotine [route, dosage and duration of treatment to reaction onset not stated]. The man, who had hypertension, felt unconscious at his working place due to ventricular fibrillation-induced sudden cardiac death. Subsequently, he was resuscitated. Thereafter, he was transferred to an external chest pain unit where clinical examination was performed which revealed coronary atheromatosis, short episode of atrial fibrillation and a transient QT interval prolongation. Hence, subcutaneous implantable cardioverter defibrillator (S-ICD) was implanted. At the same time, he had started receiving treatment with ramipril, bisoprolol, torasemid, statin and aspirin. Furthermore, he was instructed to quit smoking and the use of nicotine substitute-spray was recommended. Following cardiac rehabilitation programme, he was discharged without occurrence of angina or arrhythmic event. After 1 month, he received an adequate ICD-Shock after an angina-episode at rest with following syncope. Therefore, he presented to the outpatient clinic for treatment and further clinical evaluation. Holter-ECG revealed shortcoupled monomorphic premature ventricular contractions (PVCs) with transient ST-segment elevation. He developed ventricular fibrillation with both PVCs and ST-elevation. Due to suspicion of vasospastic angina, he was admitted to cardiology department to perform acetylcholine-provocation test. During hospitalisation, he developed an angina-episode at rest. Subsequent telemetry monitoring revealed a prominent ST-Segment elevation in leads II, III, and aVF associated with monomorphic short coupled PVCs. The man received sublingual nitrate spray with immediate subsiding of the angina-symptoms and the ST-elevation. However, he experienced same symptoms immediately following an administration of nicotine substitute-spray. Based on clinical symptoms, prinzmetal variant angina (PVA) was diagnosed. He subsequently received treatment with diltiazem, long-acting nitrate and antiplatelet therapy with clopidogrel. The physician recommended to quit nicotine abuse and nicotine-substitution indefinitely. Thereafter, he was discharged from hospital. At follow-up, he did not have had angina or arrhythmic events. Tsianakas N, et al. Holter ECG diagnosis of nicotine-spray induced ventricular fibrillation. An unusual case of Prinzmetal variant angina. Journal of Electrocardiology 63: 803517699 17-20, Nov 2020. Available from: URL: http://doi.org/10.1016/j.jelectrocard.2020.09.004
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Reactions 28 Nov 2020 No. 1832
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