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

Background: The distinction of ischemic vs. non-ischemic origin is essential for prognosis and treatment of patients (pts) with congestive heart failure (CHF). To determine etiology, pts typically undergo invasive coronary angiography (CA). Additional information can be obtained by detecting necrosis or fibrosis on delayed enhanced (DE) magnetic resonance (cMR). Recently, we and others have demonstrated that detection of myocardial necrosis is also feasible by multidetector CT (MDCT) at the time of non-invasive coronary imaging. We therefore evaluated whether such a combined and comprehensive evaluation of coronary anatomy and infarct characterization by MDCT might be useful for determining the etiology of CHF. Methods: Sixty-one consecutive pts (44 males, 60 ± 16 years) with CHF (mean ejection fraction: 26 ± 11%) of undetermined etiology underwent MDCT, DE-MR and CA. Presence of coronary artery disease (CAD) and patterns of DE on MDCT were compared to CA and DE-MR. Results: According to CA, 27 pts (44%) had significant CAD (>50% stenosis in at least one major coronary artery). DE-cMR demonstrated transmural or subendocardial DE in 21 of these 27 pts. These 21 pts were considered to have definite ischemic CHF (group 1). Among the 34 pts without CAD on CA, 23 had no DE on cMR, while 7 (11%) presented midventricular or sub-epicardial DE. These 30 pts were considered to have definite non-ischemic CHF (group 2). Four pts had transmural DE but no CAD and were considered to have probable ischemic CHF (group 3). Finally, 6 pts with CAD on CA, but without DE on cMR were considered to have probable non-ischemic CHF (group 4). Pts were also classified into the same 4 groups using coronary and DE-MDCT. On a per patient basis, agreement between coronary and DE-MDCT and CA/DE-cMR for the diagnosis of patients was excellent (κ=0.87; p<0.001). Coronary and DE-MDCT had 96% sensitivity, 92% specificity and 93% accuracy for detecting definite (group 1) or probable (group 3) ischemic CHF as compared to DE-cMR and CA. Conclusion: Combined coronary and DE-MDCT allows for the accurate differentiation of ischemic vs non ischemic etiology of CHF as compared to CA and DE-cMR. Using this single test is however cheaper and faster than combined use of DE-cMR and CA for establishing etiology of CHF.

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Takotsubo cardiomyopathy: Report of the first case series in Serbia and review of the literature

Medicinski pregled ◽

10.2298/mpns1002075p ◽

2010 ◽

Vol 63 (1-2) ◽

pp. 75-81 ◽

Cited By ~ 3

Author(s):

Biljana Putnikovic ◽

Vojkan Cvorovic ◽

Milos Panic ◽

Predrag Milicevic ◽

Gordana Vojinovic-Maglic ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery ◽

Acute Heart Failure ◽

Takotsubo Cardiomyopathy ◽

Coronary Artery Spasm ◽

Case Series ◽

Left Ventricular ◽

Coronary Microvascular Dysfunction ◽

Review Of The Literature ◽

First Case

Introduction. Takotsubo cardiomyopathy is a relatively novel cardiac syndrome that is characterized by transient left ventricular asynergy involving apical and mid-ventricular segments. Epidemiology and pathophisiology. It occurs predominantly in elderly women in the absence of obstructive coronary artery disease and is usually associated with severe emotional or physical stress. This syndrome is manifested with chest pain, electrocardiographic changes that mimic acute myocardial infarction, and minimal myocardial enzy?matic release. Several different mechanisms have been proposed: coronary artery spasm, dynamic left ventricular outflow/intracavitary obstruction, coronary microvascular dysfunction and direct catecholamine-mediated cardiomyocite injury. Therapy and prognosis. Complete recovery usually occurs after dramatic presentation, frequently complicated with acute heart failure. Therapy is empiric and directed towards supportive measures against cardiogenic shock, acute heart failure, dysrhythmias. In-hospital mortality rate is less than 1%, but long-term prognosis is still unknown. In addition to the review of the literature on takotsubo cardiomyopathy, we present the first series of patients with this syndrome detected in Clinical Hospital Center Zemun.

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The Prevalence of Silent Coronary Artery Spasm in Patient with Chronic Heart Failure

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2016.07.112 ◽

2016 ◽

Vol 22 (9) ◽

pp. S172-S173

Author(s):

Shingo Yoshioka ◽

Takashi Shimozato ◽

Hirotaka Ohtake ◽

Miyuki Ando ◽

Ryosuke Kametani

Keyword(s):

Heart Failure ◽

Coronary Artery ◽

Chronic Heart Failure ◽

Coronary Artery Spasm

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Rapid Resolution of Coronary Artery Spasm Complicated by Acute Systolic Heart Failure with Antirejection Therapy in Acute Orthotopic Heart Transplant Rejection

Cardiovascular Pharmacology Open Access ◽

10.4172/2329-6607.1000201 ◽

2016 ◽

Vol 05 (06) ◽

Author(s):

Howard Lan ◽

Liset Stoletniy ◽

Antoine Sakr ◽

Anthony Hilliard

Keyword(s):

Heart Failure ◽

Coronary Artery ◽

Heart Transplant ◽

Transplant Rejection ◽

Coronary Artery Spasm ◽

Systolic Heart Failure ◽

Orthotopic Heart Transplant ◽

Rapid Resolution ◽

Heart Transplant Rejection

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Kanker als hartenbreker: cardio-oncologie, meer dan alleen hartfalen?

Tijdschrift voor Geneeskunde ◽

10.47671/tvg.77.21.068 ◽

2021 ◽

Author(s):

B. VON KEMP ◽

S. DROOGMANS ◽

B. COSYNS

Keyword(s):

Heart Failure ◽

Coronary Artery ◽

Arterial Hypertension ◽

Cancer Treatment ◽

Kinase Inhibitors ◽

Plaque Rupture ◽

Checkpoint Inhibitors ◽

Coronary Artery Spasm ◽

Added Value ◽

Type I

Cancer treatment: it can break your heart … As cancer survival is improving, the risk for developing cardiovascular disease (CVD) from cancer treatment increases. Cancer patients and survivors are indeed susceptible for the development of cancer treatment-induced heart disease, especially if pre-existing CVD or cardiovascular risk factors (arterial hypertension, hypercholesterolemia, diabetes mellitus, smoking) are present. Every treatment class has a particular toxicity profile that requires dedicated attention. The best studied form of cardiotoxicity is anthracycline-induced heart failure ( toxicity type I, dose-dependent and irreversible). Fluoropyrimidines may induce coronary artery spasm or plaque rupture, trastuzumab may cause heart failure ( toxicity type II, usually reversible and dose-independent), and antiangiogenic treatments induce arterial hypertension. Tyrosine kinase inhibitors can cause heart failure, hypertension and QT-prolongation, and immune checkpoint inhibitors may cause life-threatening myocarditis, typically short after initiating treatment. Radiotherapy-induced valvulopathy and coronary artery disease typically manifest late (> 10 years) after treatment termination. Intensive research is being conducted in the field of cardioprotection, and a multidisciplinary approach with dedicated expertise on the topic is required when decisions about (dis-)continuation of potentially life-saving cancer treatments are to be made. A dedicated cardio-oncology clinic answers this need and is an added value for both patient and oncologist.

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Vasospastic angina pectoris complicated by acute myocardial infarction and complete atrioventricular block

Vojnosanitetski pregled ◽

10.2298/vsp1107611p ◽

2011 ◽

Vol 68 (7) ◽

pp. 611-615

Author(s):

Milan Pavlovic ◽

Goran Koracevic ◽

Snezana Ciric-Zdravkovic ◽

Nebojsa Krstic ◽

Aleksandar Stojkovic ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Spasm ◽

Myocardial Necrosis ◽

Middle Part ◽

Cold Weather ◽

Vasospastic Angina ◽

St Segment Elevation ◽

St Segment ◽

Retrosternal Pain ◽

Vasospastic Angina Pectoris

Background. A prolonged coronary artery spasm with interruption of coronary blood flow can lead to myocardial necrosis and increase of cardiospecific enzymes and can be complicated with cardiac rhythm disturbances, syncopc, or even sudden cardiac death. Case report. A 55-year old male felt a severe retrosternal pain when exposing himself to cold weather. The pain lasted for 20 minutes and was followed by the loss of conscience. Electrocardiogram (ECG) showed a complete antrioventricular (AV) block with nodal rhythm and marked elevation of ST segment in inferior leads. Electrocardiogram was soon normalized, but serum activities of cardiospecific enzymes were increased. Coronarography showed normal findings for the left coronary artery and a narrowing at the middle part of the right coronary artery, which disappeared after intracoronary application of nitroglycerine. The following therapy was prescribed: Diltiazem, Amlodipin, Isosorbid mononitrate, Molisdomin, Atrovastatin, Aspirin and Nitroglycerine spray. After 7 months medicaments were abandoned and the patient experienced again reccurent chest pain episodes at rest. Transitory ST segment elevation was recorded in inferior leads of ECG, but without increase of cardiospecific enzymes serum activities. After restoration of the medicament therapy anginal episodes ceased. Conclusion. Coronary dilators in maximal doses can prevent attacks of vasospastic angina.

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