BMJ Case Reports 2018; doi:10.1136/bcr-2017-223529
  • Unusual association of diseases/symptoms

Atherothrombotic out-of hospital cardiac arrest: watch out for a second train

  1. Olivier Varenne1,2
  1. 1Hopital Cochin, Paris, France
  2. 2Université Paris Descartes, Faculté de Médecine, Paris, France
  1. Correspondence to Dr Fabien Picard, fabien.picard{at}
  • Accepted 23 January 2018
  • Published 8 February 2018


A 63-year-old man presented with an out-of-hospital cardiac arrest. The coronary angiogram with intravascular imaging was performed and showed a mid-left anterior descending artery atherosclerotic cap rupture with thrombus burden treated with drug-eluting stent (DES) implantation. During the hospitalisation in the intensive care unit, the patient experienced recurrent ventricular fibrillations and asystole with transient ST-segment elevation in the inferior leads with normal coronary angiography. A methylergonovine provocative test was therefore performed and showed an occlusive right coronary artery (RCA) spasm. Due to recurrent RCA spasm, the patient was treated with DES implantation with favourable results at 3-month follow-up.


  • Contributors All authors treated the patient during his ICU and cardiology hospitalisation. FP and LP drafted the case report. OV and AC performed literature review, participated in writing and revised the case report critically for important intellectual content. All authors have approved the manuscript and agree with its submission. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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