• Kang Song, Yang Ji, Kun Zhao, Xiaorong Han, Chuanmin Jian, and Song Liu.
• Department of Cardiovascular Medicine, Qingdao University, Qingdao, China.
• Medicine (Baltimore). 2023 Dec 15; 102 (50): e36400e36400.

RationaleCoronary artery spasms may result from supply-demand mismatch due to hypotension. Norepinephrine is more effective in ameliorating antipsychotic-induced refractory hypotension.Patient ConcernsPostoperative difficult-to-correct hypoperfusion occurs in patients with comorbid depression and coronary spasm; the use of norepinephrine and epinephrine for rapidly raising blood pressure needs to be considered.DiagnosesElectrocardiogram is an auxiliary tool and Digital Substraction Angiography is the gold standard for the diagnosis.InterventionsSurgery and correct choice of raising blood pressure are the main treatment methods.OutcomesHypotension induced by the use of antipsychotics after angiography is difficult to correct with dobutamine, and the above scenario is relatively rare in the clinic, where norepinephrine could be a potential therapeutic option.LessonsBased on the lessons learnt from this case, caution must be exercised when dealing with patients on multiple antipsychotics during the perioperative period, while pressor-boosting medications should not be limited to conventional drugs such as dopamine. Norepinephrine may be more effective in dealing with difficult-to-correct hypoperfusion.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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