Alternate recurrent coronary artery spasm and stress cardiomyopathy: a case report

Abstract

Background Coronary artery spasm (CAS) and stress cardiomyopathy (SC) have different characteristic clinical manifestations in the case of suspicious myocardial infarction with nonobstructive coronary arteries. Established recurrence rates of both conditions have been reported, however, alternate recurrent CAS and SC in the same individual have not been described. Case presentation A 59-year-old man suffered from atypical chest pain in the first episode, acute heart attack in the second and third episodes (totally 3 times over a period of approximately 5 years). During the first episode, he visited our hospital with mild paroxysmal chest pain without obvious inducement for approximately 2 years. He was underdiagnosed at that time without other obvious findings except the poor R wave progression in V1–3 leads revealed in electrocardiogram. At 4 months after the first episode, he suffered from a heart attack (the second episode) and was diagnosed with SC based on the coronary angiography (CAG) and left ventriculography findings of nonobstructive coronary arteries combined with a classic apical ballooning shape. At 31 months after the second episode, he suffered another heart attack (the third episode) and was diagnosed with CAS based on the CAG results of recoverable severe multivessel stenoses. During the episodes, partial reversible nature of apical hypokinesis was observed in echocardiogram. In retrospect, the patient suffered silent CAS in the first episode, SC in the second episode, and severe multivessel CAS in the third episode. Conclusion The unusual presentations observed in this case have not been reported. This case suggests that cardiologists should be aware of the possibility of alternate recurrent CAS and SC in the same individual. Provocative tests for spasm and cardiac magnetic resonance imaging might help gain more insights into this issue.

Serial changes of myocardial perfusion imaging in takotsubo and reverse takotsubo cardiomyopathy

“…25 Conversely, provoked coronary spasm cases in patients with TTC have been reported and their variants from the early era of discovering this syndrome to the present. 1,6,[33][34][35][36][37][38][39][40] This discrepancy in the relationship between TTC and spasm may be due to the sensitivity of the ACh provocation test. Sueda et al reported that intracoronary injection of ACh is less sensitive for diagnosis in young patients with rest angina and recommend performing sequential spasm provocation tests of ACh and ergonovine.…”

“…Single photon emission computed tomography (SPECT) was performed simultaneously in both groups in the respective acute and chronic phases. In the acute phase, SPECT was performed within a few days after admission (TTC: 3.0 [2.0-3.3] days vs rTTC: 3.0 [2.0-3.0] days, P = 0.72), and in the chronic phase, SPECT was performed approximately one month after admission (TTC: 33 [26][27][28][29][30][31][32][33][34][35][36][37] days vs rTTC: 35 days, P = 0.63).…”

Coronary Artery Spasm-Related Heart Failure Syndrome: Literature Review

“…Angelini reported 4 cases of Takotsubo cardiomyopathy in which echocardiographic apical ballooning or similar symptoms could be reproduced by provocative CAS [228]. Moreover, it has also been demonstrated that alternate recurrent CAS and Takotsubo cardiomyopathy can exist in the same individual [229]. These observations underscore the importance of CAS as a culprit process underlying Takotsubo cardiomyopathy and the targeted treatments accordingly.…”

Takotsubo Syndrome: Translational Implications and Pathomechanisms

“…A failure of coronary vasomotor function was demonstrated in most TTS patients. TTS and anomalous coronary artery coexisted or recurred alternately in the same individual [101,103]. Whether TTS and coronary artery spasm are two expressions of the same disease or, rather, two separate entities with overlapping mechanisms is also unclear [104].…”