title: Heart failure with silent coronary artery spasm exhibiting microscopic focal myocardial necrosis and amyloid-deposition.
abstract: 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.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University, Kumamoto.
authors.forename: Satoru
authors.initials: S
authors.lastname: Suzuki
authors.forename: Seigo
authors.initials: S
authors.lastname: Sugiyama
authors.forename: Hiroki
authors.initials: H
authors.lastname: Usuku
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Hirai
authors.forename: Koichi
authors.initials: K
authors.lastname: Kaikita
authors.forename: Naomi
authors.initials: N
authors.lastname: Sakashita
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshimura
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: 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
chemical_list: D000682:Amyloid; D014665:Vasodilator Agents; D000109:Acetylcholine