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[Coronary spasm and diffuse coronary vasoconstriction responsible for transient left ventricular insufficiency]
C Fournier1, B Boujon, J L Hebert
1Service de cardiologie, hôpital de Bicêtre, Kremlin-Bicêtre.
Archives Des Maladies Du Coeur Et Des Vaisseaux
|July 1, 1991
Summary
Coronary artery spasms, even without organic heart disease, can cause severe left ventricular dysfunction and heart failure symptoms. These spasms can lead to prolonged ECG abnormalities and impaired heart function.
Area of Science:
- Cardiology
- Vascular Medicine
- Physiology
Background:
- Spontaneous coronary artery spasm (SCAS) is a significant cause of angina.
- Left ventricular (LV) failure can arise from various cardiac conditions, including ischemia.
Observation:
- A 52-year-old patient presented with severe anginal chest pain and signs of LV failure.
- Coronary angiography revealed localized coronary artery spasm and hypokinesis.
- Intracoronary molsidomine administration led to regression of spasm and LV failure symptoms.
Findings:
- Coronary artery spasm induced significant, albeit transient, left ventricular dysfunction.
- LV failure signs resolved within 48 hours, while echocardiographic abnormalities regressed over 3 days.
- Electrocardiogram (ECG) showed prolonged anterior wall subendocardial ischemia and QTc interval prolongation.
Implications:
- Coronary vasospasm can precipitate severe, transient LV dysfunction and clinical heart failure in the absence of obstructive coronary artery disease.
- Prolonged ECG abnormalities may persist long after the acute vasospastic event.
- Understanding vasospasm's impact is crucial for managing angina and preventing cardiac dysfunction.
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