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Acute Heart Failure Triggered by Coronary Spasm With Transient Left Ventricular Dysfunction
Yusuke Adachi1, Kenichi Sakakura, Tatsuro Ibe
1Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University.
Insights
Coronary spasm, an abnormal artery contraction, can cause acute heart failure. The acetylcholine provocation test aids in diagnosing this condition and elevated ventricular filling pressure.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Coronary spasm involves abnormal contraction of epicardial coronary arteries, leading to myocardial ischemia.
- This condition impairs myocardial contractility and relaxation, resulting in elevated ventricular filling pressure.
Observation:
- A 55-year-old woman experienced recurrent acute heart failure attributed to coronary spasm.
- The patient presented with symptoms suggestive of heart failure, prompting further investigation.
Findings:
- Acetylcholine provocation testing combined with right heart catheterization effectively diagnosed both coronary artery spasm and elevated ventricular filling pressure.
- Diagnostic confirmation was achieved through invasive hemodynamic monitoring and provocative testing.
Implications:
- Coronary spasm should be considered in the differential diagnosis for patients with repeated episodes of acute heart failure.
- Early recognition and diagnosis of coronary spasm can improve patient outcomes and guide appropriate management strategies.
Abstract:
Coronary spasm is abnormal contraction of an epicardial coronary artery resulting in myocardial ischemia. Coronary spasm induces not only depressed myocardial contractility, but also incomplete myocardial relaxation, which leads to elevated ventricular filling pressure. We herein report the case of a 55-year-old woman who had repeated acute heart failure caused by coronary spasm. Acetylcholine provocation test with simultaneous right heart catheterization was useful for the diagnosis of elevated ventricular filling pressure as well as coronary artery spasm. We should add coronary spasm to a differential diagnosis for repeated acute heart failure.