Background: Sudden cardiac death (SCD) is commonly linked to coronary artery disease (CAD), often involving plaque rupture or erosion. Intraplaque hemorrhage (IPH) has emerged as a significant factor in SCD.
Case Summary: A 39-year-old man experienced intermittent chest pain before collapsing with ventricular fibrillation cardiac arrest. Coronary angiography revealed significant stenosis in the left anterior descending artery. Optical coherence tomography identified IPH. Coronary spasm was confirmed by acetylcholine testing. The patient was treated with percutaneous coronary intervention and long-term medical therapy including antiplatelet therapy and calcium channel blocker, with no adverse events over 3 years.
Discussion: This case underscores the importance of recognizing IPH and coronary spasm as contributors to SCD. Recent pathologic findings suggest a notable association between IPH and coronary spasm
JACC Case Reports Interim Editors-in-Chief
Gilbert H. L. Tang, MD, MSc, MBA
CME Editor
Kenneth A. Ellenbogen, MD
Author
Stephen Clarkson, MD
Important Dates
Date of Release: May 7, 2025
Term of Approval/Date of CME/MOC Expiration: May 6, 2026