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Familial catamenial coronary spasms

Elisabeth A A de Groot1, Loek van Heerebeek1, Maarten A Vink2

  • 1Cardiology, Onze Lieve Vrouwe Hospital, Amsterdam, The Netherlands.

BMJ Case Reports
|September 25, 2024
PubMed

Insights

Catamenial coronary spasms (CS), linked to menstruation, can cause myocardial infarction in young women. Early diagnosis and hormone-based treatments are crucial for managing this condition.

Area of Science:

  • Cardiology
  • Endocrinology
  • Reproductive Medicine

Background:

  • Coronary artery spasms are a significant cause of myocardial ischemia and infarction, particularly in patients with non-obstructive coronary artery disease.
  • These spasms affect younger individuals and occur with similar frequency in both sexes, with potential hormonal influences beyond traditional risk factors like smoking.

Observation:

  • The study presents two young sisters experiencing myocardial infarction attributed to catamenial coronary spasms (CS) during menstruation.
  • In one case, CS led to severe heart failure, reduced ejection fraction, and necessitated a heart transplant due to refractory ventricular arrhythmias.

Findings:

  • Catamenial coronary spasms may be triggered by hormonal fluctuations, specifically estrogen and progesterone levels, during the menstrual cycle.
  • This hormonal link suggests a distinct pathophysiology for CS in susceptible individuals.

Implications:

  • Increased clinical awareness of catamenial coronary spasms is vital for timely diagnosis.
  • Effective management strategies may involve coronary vasodilators and/or targeted hormone replacement therapies, such as estrogen/progesterone regimens.

Keywords:
ArrhythmiasEstrogensHeart failureInterventional cardiologyMenopause (including HRT)

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