Heart failure with silent coronary artery spasm exhibiting microscopic focal myocardial necrosis and amyloid-deposition.
We report a 67-year-old Japanese man who presented with worsening heart failure with asymptomatically transient ischemic ST-segment depression. Left ventriculography showed diffuse hypokinesis; asymptomatic coronary artery spasm was evoked by the acetylcholine provocation test. Endomyocardial biopsy exhibited hypertrophic cardiomyocytes and scattered microscopic focal myocardial necrosis with amyloid-deposition. Transient ST-segment depression improved after treatment with a calcium antagonist, but cardiac contraction was still impaired. We hypothesize that asymptomatic coronary spasm may cause irreversible cardiac damage and heart failure with amyloid-deposition; the presence or absence of coronary spasm in heart failure patients should be clarified in order to determine therapeutic strategy.
Suzuki
Satoru
S
Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University, Kumamoto.
Sugiyama
Seigo
S
Usuku
Hiroki
H
Hirai
Nobutaka
N
Kaikita
Koichi
K
Sakashita
Naomi
N
Sakamoto
Tomohiro
T
Yoshimura
Michihiro
M
Ogawa
Hisao
H
D000109:Acetylcholine; D000368:Aged; D000682:Amyloid / Q000378:metabolism*; D002303:Cardiac Output, Low / Q000150:complications* / Q000473:pathology; D003329:Coronary Vasospasm / Q000150:complications* / Q000378:metabolism / Q000473:pathology*; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000209:etiology; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D014665:Vasodilator Agents; D018487:Ventricular Dysfunction, Left
D000682:Amyloid; D014665:Vasodilator Agents; D000109:Acetylcholine