Alternate recurrent coronary artery spasm and stress cardiomyopathy: a case report
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CASE REPORT
Alternate recurrent coronary artery spasm and stress cardiomyopathy: a case report Yunpeng Jin1, Qiming Li1 and Xiaogang Guo2*
Abstract Background: Coronary 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 presentation: A 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. Conclusion: The 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. Keywords: Case report, Coronary artery spasm, Apical ballooning shape, Stress cardiomyopathy, Myocardial infarction with nonobstructive coronary arteries, Takotsubo syndrome Background Coronary artery spasm (CAS) generally causes transient myocardial ischemia with the manifestations of paroxysmal chest pain and recoverable electrocardiogram (ECG) changes; however, it may also cause life-threatening heart events such as acute myocardial infarction (AMI), lethal *Correspondence: [email protected] 2 Division of Cardiology, The First Affiliated Hospital of Zhejiang University School of Medicine, N79 Qingchun Road, Hangzhou 310003, Zhejiang, People’s Republic of China Full list of author information is available at the end of the article
arrhythmias, and even sudden death despite its transient nature, especially in the case of multivessel involvement [1]. A definite and timely diagnosis of CAS remains extremely challenging because provocation tests are rarely performed due to the concern regarding i
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