Heart Failure with Silent Coronary Artery Spasm Exhibiting Microscopic Focal Myocardial Necrosis and Amyloid-Deposition

Satoru SUZUKI; Seigo SUGIYAMA; Hiroki USUKU; Nobutaka HIRAI; Koichi KAIKITA; Naomi SAKASHITA; Tomohiro SAKAMOTO; Michihiro YOSHIMURA; Hisao OGAWA

doi:10.2169/internalmedicine.43.199

Cardiovascular Diseases

Heart Failure with Silent Coronary Artery Spasm Exhibiting Microscopic Focal Myocardial Necrosis and Amyloid-Deposition

Satoru SUZUKI, Seigo SUGIYAMA, Hiroki USUKU, Nobutaka HIRAI, Koichi KAIKITA, Naomi SAKASHITA, Tomohiro SAKAMOTO, Michihiro YOSHIMURA, Hisao OGAWA

Author information

Satoru SUZUKI
Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University
Seigo SUGIYAMA
Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University
Hiroki USUKU
Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University
Nobutaka HIRAI
Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University
Koichi KAIKITA
Department of Cell Pathology, Graduate School of Medical Sciences Kumamoto University
Naomi SAKASHITA
Department of Cell Pathology, Graduate School of Medical Sciences Kumamoto University
Tomohiro SAKAMOTO
Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University
Michihiro YOSHIMURA
Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University
Hisao OGAWA
Department of Cardiovascular Medicine, Graduate School of Medical Sciences Kumamoto University

Keywords: coronary spasm, amyloid, heart failure, ischemic heart disease

JOURNAL OPEN ACCESS

2004 Volume 43 Issue 3 Pages 199-203

DOI https://doi.org/10.2169/internalmedicine.43.199

Details

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.

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