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Acute Heart Failure Due to Multi-vessel Coronary Spasm
Hiroki Teragawa1, Ayaka Shirai2, Chikage Oshita1
1Department of Cardiovascular Medicine, JR Hiroshima Hospital, Japan.
Internal Medicine (Tokyo, Japan)
|May 10, 2023
Summary
Coronary artery spasm can cause heart failure with preserved ejection fraction (HFpEF), even without significant blockages. This finding highlights the importance of considering coronary spasm in heart failure diagnoses.
Area of Science:
- Cardiology
- Internal Medicine
- Cardiovascular Research
Background:
- Heart failure with preserved ejection fraction (HFpEF) presents diagnostic challenges, often lacking clear obstructive coronary artery disease.
- Myocardial enzyme levels, ECG, and echocardiography can be normal in some HFpEF patients, necessitating further investigation.
Observation:
- A 46-year-old male presented with chest pain, dyspnea, and cough, initially diagnosed with HFpEF based on chest radiography showing congestion.
- Despite initial improvement with diuretics, coronary angiography revealed no significant stenosis, but a spasm provocation test confirmed multi-vessel coronary artery spasm.
Findings:
- The patient's symptoms were attributed to diffuse coronary artery spasms, not typical atherosclerotic narrowing.
- This case demonstrates that coronary artery spasm can be a primary cause of HFpEF.
Implications:
- Coronary artery spasm should be considered a critical differential diagnosis in patients presenting with heart failure, particularly HFpEF.
- Spasm provocation testing may be crucial for diagnosing HFpEF in the absence of obstructive coronary artery disease.
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