Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Keelung, Chang Gung University College of Medicine, Keelung City 24201, Taiwan.
Department of Medical Research and Education, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
Int J Mol Sci. 2023 Apr 19;24(8):7530. doi: 10.3390/ijms24087530.
Although heart failure (HF) is a clinical syndrome that becomes worse over time, certain cases can be reversed with appropriate treatments. While coronary artery spasm (CAS) is still underappreciated and may be misdiagnosed, ischemia due to coronary artery disease and CAS is becoming the single most frequent cause of HF worldwide. CAS could lead to syncope, HF, arrhythmias, and myocardial ischemic syndromes such as asymptomatic ischemia, rest and/or effort angina, myocardial infarction, and sudden death. Albeit the clinical significance of asymptomatic CAS has been undervalued, affected individuals compared with those with classic Heberden's angina pectoris are at higher risk of syncope, life-threatening arrhythmias, and sudden death. As a result, a prompt diagnosis implements appropriate treatment strategies, which have significant life-changing consequences to prevent CAS-related complications, such as HF. Although an accurate diagnosis depends mainly on coronary angiography and provocative testing, clinical characteristics may help decision-making. Because the majority of CAS-related HF (CASHF) patients present with less severe phenotypes than overt HF, it underscores the importance of understanding risk factors correlated with CAS to prevent the future burden of HF. This narrative literature review summarises and discusses separately the epidemiology, clinical features, pathophysiology, and management of patients with CASHF.
尽管心力衰竭（HF）是一种随着时间推移而恶化的临床综合征，但某些病例可以通过适当的治疗得到逆转。虽然冠状动脉痉挛（CAS）仍然未被充分认识，并且可能被误诊，但由于冠状动脉疾病和 CAS 引起的缺血已成为全球 HF 的单一最常见原因。CAS 可导致晕厥、HF、心律失常和心肌缺血综合征，如无症状性缺血、静息和/或劳力性心绞痛、心肌梗死和猝死。尽管无症状性 CAS 的临床意义被低估，但与经典 Heberden 心绞痛患者相比，受影响的个体发生晕厥、危及生命的心律失常和猝死的风险更高。因此，及时诊断并采取适当的治疗策略，对预防与 CAS 相关的并发症（如 HF）具有重大的改变生活的意义。虽然准确的诊断主要取决于冠状动脉造影和激发试验，但临床特征可能有助于决策。由于大多数与 CAS 相关的 HF（CASHF）患者的表型比明显 HF 患者的表型更轻，因此强调了了解与 CAS 相关的风险因素以预防未来 HF 负担的重要性。本叙述性文献综述分别总结和讨论了 CASHF 患者的流行病学、临床特征、病理生理学和管理。
Zotero 插件
