A 37-year-old woman without history of
ischemic heart disease or any coronary risk factors was scheduled for
caesarean section. Under
spinal anesthesia, the patient's blood pressure (BP) decreased to 93/72 mmHg. Although 6 mg of
ephedrine was administered intravenously, BP continued to decrease to 75/40 mmHg and she complained of
nausea. In addition to additional
ephedrine (12 mg),
phenylephrine (0.1 mg) and
atropine (0.5 mg) were administered. BP increased to 170/100 mmHg, but electrocardiogram (ECG) showed ST elevation in I and aV(L), ST depression in II, III, aV(F), and frequent
premature ventricular beats, and the patient complained of chest discomfort. Coronary dilators and
lidocaine promptly reversed the ST elevation,
premature ventricular beats and discomfort. The operation was started promptly and was uneventful. Although BP decreased again to 75/45 mmHg at the beginning of the operation, we did not use vasopressors to avoid the relapse of
myocardial ischemia. The
anesthetic course was uneventful thereafter. This
cardiac event seemed to be derived from coronary
spasm caused by acute sympathetic stimulation. The observations in this case suggest that the possibility of intraoperative coronary
spasm should be considered even in a healthy patient.