Alternate recurrent coronary artery spasm and stress cardiomyopathy: a case report

BMC Cardiovascular Disorders

Xiaogang Guo¹  Qiming Li²  Yunpeng Jin² 

[1] Division of Cardiology, The First Affiliated Hospital of Zhejiang University School of Medicine, N79 Qingchun Road, 310003, Hangzhou, Zhejiang, People’s Republic of China;Division of Cardiology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, N1 Shangcheng Road, 322000, Yiwu, Zhejiang, People’s Republic of China;

关键词: Case report;    Coronary artery spasm;    Apical ballooning shape;    Stress cardiomyopathy;    Myocardial infarction with nonobstructive coronary arteries;    Takotsubo syndrome;   

DOI  :  10.1186/s12872-020-01760-2

来源: Springer

【 摘 要 】

BackgroundCoronary artery spasm (CAS) and stress cardiomyopathy (SC) have different characteristic clinical manifestations in the case of suspicious myocardial infarction with nonobstructive coronary arteries. Established recurrence rates of both conditions have been reported, however, alternate recurrent CAS and SC in the same individual have not been described.Case presentationA 59-year-old man suffered from atypical chest pain in the first episode, acute heart attack in the second and third episodes (totally 3 times over a period of approximately 5 years). During the first episode, he visited our hospital with mild paroxysmal chest pain without obvious inducement for approximately 2 years. He was underdiagnosed at that time without other obvious findings except the poor R wave progression in V1–3 leads revealed in electrocardiogram. At 4 months after the first episode, he suffered from a heart attack (the second episode) and was diagnosed with SC based on the coronary angiography (CAG) and left ventriculography findings of nonobstructive coronary arteries combined with a classic apical ballooning shape. At 31 months after the second episode, he suffered another heart attack (the third episode) and was diagnosed with CAS based on the CAG results of recoverable severe multivessel stenoses. During the episodes, partial reversible nature of apical hypokinesis was observed in echocardiogram. In retrospect, the patient suffered silent CAS in the first episode, SC in the second episode, and severe multivessel CAS in the third episode.ConclusionThe unusual presentations observed in this case have not been reported. This case suggests that cardiologists should be aware of the possibility of alternate recurrent CAS and SC in the same individual. Provocative tests for spasm and cardiac magnetic resonance imaging might help gain more insights into this issue.

【 授权许可】

CC BY