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Coronary Artery Spasm as a Contributor to Heart Failure: Lessons from Three Cases

Ayami Naito1, Takumi Toya1,2, Akane Kawai1

  • 1Department of Cardiology, National Defense Medical Collage, Japan.

Internal Medicine (Tokyo, Japan)
|March 30, 2025
PubMed

Insights

Coronary artery spasm (CAS) can cause heart failure even without blocked arteries. Provocation testing confirmed CAS in three patients, and treatment with calcium channel blockers improved their heart failure symptoms.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Coronary artery spasm (CAS) is an underrecognized cause of heart failure.
  • CAS can lead to heart failure even in the absence of obstructive coronary artery disease.

Purpose of the Study:

  • To highlight coronary artery spasm (CAS) as a critical etiology of heart failure.
  • To emphasize the importance of provocation testing and tailored therapy for CAS-induced heart failure.

Main Methods:

  • Case series of three patients presenting with heart failure and nonobstructive coronary arteries.
  • Coronary artery spasm (CAS) provocation testing to confirm epicardial spasm.
  • Cardiac magnetic resonance imaging (CMR) to assess for ischemic patterns.

Main Results:

  • CAS was identified as the critical etiology for heart failure in all three patients.
  • CAS provocation testing confirmed epicardial spasm.
  • Cardiac magnetic resonance imaging revealed ischemic patterns consistent with CAS-related injuries in two patients.
  • Calcium channel blockers effectively stabilized heart failure signs and symptoms.

Conclusions:

  • Coronary artery spasm (CAS) is a significant contributor to heart failure progression.
  • Provocation testing is crucial for diagnosing CAS-induced heart failure.
  • Early, tailored therapy, including calcium channel blockers, improves outcomes for patients with CAS-related heart failure.

Keywords:
heart failureischemia with nonobstructive coronary arteriesmyocardial injury with nonobstructive coronary arteriesvasospastic angina

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