{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T16:29:00Z","timestamp":1755793740515,"version":"3.44.0"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:00:00Z","timestamp":1755216000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Diffuse coronary artery spasm (DMV-CAS) is a serious vascular condition characterized by prolonged narrowing of two or more major coronary arteries or their main branches, leading to significant stenosis or blockage (\u226570%). This can result in myocardial ischemia, heart attacks, and dangerous arrhythmias. A 68-year-old male with a four-year history of recurrent angina presented with acute-onset chest tightness, palpitations, and syncope. During transport, the patient experienced prehospital cardiopulmonary arrest, with transient return of spontaneous circulation (ROSC) achieved in the emergency department. Electrocardiographic evaluation revealed atrial fibrillation with rapid ventricular rate, pathological Q waves in the inferior, anterior, and anterior septal territories, along with dynamic ST-T abnormalities, including ST elevation in leads II, III, aVF, and V1-6, and ST depression in leads I and aVL. Emergent coronary angiography identified critical multivessel stenoses, with the most significant narrowing observed in the left anterior descending artery. The diagnosis of DMV-CAS was corroborated through angiographic evidence, demonstrating resolution of the spasm following the administration of intracoronary nitroglycerin (200 \u03bcg administered bilaterally to the coronary arteries). Despite the implementation of targeted vasodilator therapy, the patient progressed to refractory cardiogenic shock and succumbed in the intensive care unit 1\u2005h after the procedure. This case underscores the rare and severe cardiovascular implications of DMV-CAS, emphasizing the critical need for early and accurate diagnosis of DMV-CAS and the necessity for standardized pharmacological intervention.<\/jats:p>","DOI":"10.3389\/fcvm.2025.1647748","type":"journal-article","created":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T05:28:15Z","timestamp":1755235695000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Sudden cardiac death due to spasm of multiple coronary arteries"],"prefix":"10.3389","volume":"12","author":[{"given":"JiaQi","family":"Tang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"YanDan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"MingLei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ChenChen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e36889","DOI":"10.1097\/MD.0000000000036889","article-title":"Sudden diffuse spasm of multiple coronary arteries: a case report","volume":"103","author":"Cai","year":"2024","journal-title":"Medicine (Baltimore)"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1687.e9","DOI":"10.1016\/j.cjca.2018.08.022","article-title":"Coronary vasospasm following heart transplantation: rapid progression to aggressive cardiac allograft vasculopathy","volume":"34","author":"Bertic","year":"2018","journal-title":"Can J Cardiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"ytad220","DOI":"10.1093\/ehjcr\/ytad220","article-title":"Cardiac tamponade-mediated generalized coronary vasospasm presenting as an inferior ST-segment elevation myocardial infarction: a case report","volume":"7","author":"Saxon","year":"2023","journal-title":"Eur Heart J Case Rep"},{"key":"B4","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1253\/circj.CJ-22-0779","article-title":"JCS\/CVIT\/JCC 2023 guideline focused update on diagnosis and treatment of vasospastic angina (coronary spastic angina) and coronary microvascular dysfunction","volume":"87","author":"Hokimoto","year":"2023","journal-title":"Circ J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e52","DOI":"10.1056\/NEJMicm1614640","article-title":"Coronary-artery vasospasm","volume":"376","author":"Kondo","year":"2017","journal-title":"N Engl J Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.7150\/ijms.43472","article-title":"Myocardial ischemic syndromes, heart failure syndromes, electrocardiographic abnormalities, arrhythmic syndromes and angiographic diagnosis of coronary artery spasm: literature review","volume":"17","author":"Hung","year":"2020","journal-title":"Int J Med Sci"},{"key":"B7","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1016\/j.jacc.2011.11.015","article-title":"High prevalence of a pathological response to acetylcholine testing in patients with stable angina pectoris and unobstructed coronary arteries. The ACOVA study (Abnormal COronary VAsomotion in patients with stable angina and unobstructed coronary arteries)","volume":"59","author":"Ong","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"53","DOI":"10.2183\/pjab.95.005","article-title":"Coronary artery spasm\u2014clinical features, pathogenesis and treatment","volume":"95","author":"Yasue","year":"2019","journal-title":"Proc Jpn Acad Ser B Phys Biol Sci"},{"key":"B9","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/s0167-5273(99)00172-2","article-title":"Comparison of the risk factors for coronary artery spasm with those for organic stenosis in a Japanese population: role of cigarette smoking","volume":"72","author":"Takaoka","year":"2000","journal-title":"Int J Cardiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e77655","DOI":"10.1371\/journal.pone.0077655","article-title":"C-reactive protein for predicting prognosis and its gender-specific associations with diabetes mellitus and hypertension in the development of coronary artery spasm","volume":"8","author":"Hung","year":"2013","journal-title":"PLoS One"},{"key":"B11","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1161\/CIRCRESAHA.116.308334","article-title":"Atherosclerosis: successes, surprises, and future challenges","volume":"118","author":"Libby","year":"2016","journal-title":"Circ Res"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2779","DOI":"10.1253\/circj.cj-66-0098","article-title":"Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) (JCS 2013)","volume":"78","year":"2014","journal-title":"Circ J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"102554","DOI":"10.1016\/j.jaccas.2024.102554","article-title":"Coronary vasospasm presenting in a catastrophic way","volume":"29","author":"Wong","year":"2024","journal-title":"JACC Case Rep"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1016\/j.hlc.2024.04.299","article-title":"Protocol variation in functional coronary angiography among patients with suspected angina with non-obstructive coronary arteries: a nationwide snapshot of current practice within Australia and New Zealand","volume":"33","author":"Spiro","year":"2024","journal-title":"Heart Lung Circ"},{"key":"B15","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1093\/eurheartj\/ehu313","article-title":"Prognostic impact of chronic nitrate therapy in patients with vasospastic angina: multicentre registry study of the Japanese coronary spasm association","volume":"36","author":"Takahashi","year":"2015","journal-title":"Eur Heart J"},{"key":"B16","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1016\/j.ijcard.2016.08.229","article-title":"Impact of statin therapy on long-term clinical outcomes of vasospastic angina without significant stenosis: a propensity-score matched analysis","volume":"223","author":"Oh","year":"2016","journal-title":"Int J Cardiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1161\/hc1002.105938","article-title":"Suppression of coronary artery spasm by the rho-kinase inhibitor fasudil in patients with vasospastic angina","volume":"105","author":"Masumoto","year":"2002","journal-title":"Circulation"},{"key":"B18","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1177\/1074248416640161","article-title":"Pharmacotherapy of vasospastic angina","volume":"21","author":"Harris","year":"2016","journal-title":"J Cardiovasc Pharmacol Ther"},{"key":"B19","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/j.jjcc.2012.02.007","article-title":"Impact of low-dose aspirin on coronary artery spasm as assessed by intracoronary acetylcholine provocation test in Korean patients","volume":"60","author":"Park","year":"2012","journal-title":"J Cardiol"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1647748\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T05:28:16Z","timestamp":1755235696000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1647748\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,15]]},"references-count":19,"alternative-id":["10.3389\/fcvm.2025.1647748"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1647748","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,15]]},"article-number":"1647748"}}