Heart Failure in Which Coronary Spasms Played an Important Role

Abstract

A 69-year-old woman was admitted for further examinations and treatment of chest pain. Emergency cardiac catheterization showed no significant stenosis on coronary angiograms; however, diffuse wall hypokinesis was observed on a left ventriculogram. After treating the patient's heart failure, cardiac catheterization was performed again. A spasm provocation test showed coronary spasms of the right and left coronary arteries. A right ventricular endomyocardial biopsy revealed denaturation and fibrosis of the myocardium under the endocardium, thus suggesting the presence of myocardial ischemia. This case highlights coronary spasms as a cause of heart failure.

Rapid Resolution of Coronary Artery Spasm Complicated by Acute Systolic Heart Failure with Antirejection Therapy in Acute Orthotopic Heart Transplant Rejection

“…The current case report may also have important treatment implications in patients with CAS who are in acute OHT rejection. CAS can cause life threatening conditions including coronary artery occlusion, coronary ischemia, ventricular fibrillation, cardiac arrest [11,14,16], and in our case acute decompensated systolic heart failure [17,18]. The CAS marginally improved with sublingual nitroglycerin but did not achieve complete distal flow normalization until patient received antirejection immunosuppressive therapy for acute OHT rejection with methylprednisolone.…”

Coronary spasm: It’s common, but it’s still unsolved

“…The monotherapy of β-blockers is class III in VSA patients with organic stenosis[ 28 ]. However, VSA is accompanied with many cardiovascular diseases, in which β blockers are effective, such as left ventricular dysfunction[ 10 - 12 ], hypertrophic cardiomyopathy[ 66 ], and myocardial bridging[ 24 , 26 , 27 , 62 , 67 ]. Under such conditions, coronary vasodilators should be administered first, and then β blockers should be administered from small doses, observing carefully for the worsening of chest symptoms and hemodynamics.…”

“…Coronary spasm is caused by transient narrowing due to the vasoconstriction of the epicardial coronary arteries, leading to myocardial ischemia, and it plays pivotal roles in the cause of not only rest angina but also exertional angina, acute coronary syndrome, including unstable angina, acute myocardial infarction, and ischemic sudden death[ 4 - 9 ]. Recently, coronary spasm has been considered one of the causes of heart failure with reduced ejection fraction[ 10 - 12 ]. Mechanisms responsible for coronary spasm were reported to be the abnormal response of the autonomic nervous system[ 13 ], endothelial dysfunction[ 14 - 17 ], abnormal or hyper-reaction of vascular smooth muscles[ 18 - 20 ], and other factors, such as magnesium deficiency[ 21 , 22 ], inheritance[ 23 ], or specific anatomy of the coronary artery[ 24 - 27 ].…”

Acute Heart Failure Due to Multi-vessel Coronary Spasm

“…It has been widely accepted that coronary spasm is the pathogenesis of not only rest angina but also other types of coronary artery disease (CAD), including exertional angina, acute coronary syndrome, and ischemic sudden death (3). Consequently, coronary spasm is considered a possible cause of heart failure (HF) (4)(5)(6)(7)(8). In such reports (4)(5)(6)(7)(8), coronary spasm was associated with the presence of HF with a reduced ejection fraction (HFrEF) or transient left ventricular (LV) dysfunction.…”