Successful use of levosimendan in managing refractory coronary vasospasm leading to recurrent cardiac arrests: a case report

Background: Refractory coronary artery vasospasm is a challenging condition unresponsive to standard vasodilator therapy. It can be life-threatening and precipitate arrhythmias and cardiac arrest. Levosimendan, a calcium-sensitizer and ATP-sensitive potassium channel opener, is an inodilator in acute heart failure and may offer therapeutic benefit in this setting. Case presentation: A 57-year-old man with an established diagnosis of coronary vasospasm presented with ST-elevation in the inferior leads and suffered multiple cardiac arrests, initially treated with electrical defibrillation and advanced life support measures. Angiography showed mild coronary artery disease, unchanged from the previous ones. In the intensive care unit, recurrent episodes of vasospasm persisted despite maximally tolerated medical therapy. Levosimendan was initiated at 0.2 mcg/kg/min for 24 h, leading to stabilization with no further episodes of ST-elevation and arrhythmias, and he was eventually discharged from the hospital. Conclusions: Levosimendan may be an effective rescue therapy in refractory coronary vasospasm, particularly when conventional vasodilators fail and haemodynamic instability limits escalation. Its dual action improves cardiac contractility and induces significant vasodilation, targeting key pathophysiologic processes. The presented case highlights the potential of levosimendan in stabilizing patients with refractory coronary vasospasm when conventional therapies fail. Further research and clinical trials are warranted to establish its efficacy and safety profile in a broader patient population.