Alajlouni Oumara, Shahab Saba, Nouraei Hirmand, Glick Lauren, Koppikar Sahil
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
JACC Case Rep. 2025 Jul 23;30(20):104139. doi: 10.1016/j.jaccas.2025.104139.
Coronary vasospasms refractory to calcium channel blockers and nitrates may be secondary to a systemic process. Although rare, eosinophilic granulomatosis with polyangiitis (EGPA) can cause coronary vasospasms.
A 33-year-old woman presented with recurrent chest pain leading to multiple episodes of cardiac arrest. Rising eosinophilia and coronary intimal thickening were noted, and cardiac magnetic resonance imaging showed scarring. Owing to the high index of suspicion for EGPA, she was started on steroid therapy and cyclophosphamide. With this treatment, she had no further episodes of cardiac symptoms.
Cardiac involvement in EGPA is rare and carries a poor prognosis. The most common cardiac manifestations are congestive heart failure, pericarditis, myocarditis, and arrhythmias.
TAKE-HOME MESSAGES: EGPA should be considered in the differential diagnosis for patients with refractory coronary vasospasms and eosinophilia >10%. EGPA cannot be ruled out solely based on the absence of antineutrophil cytoplasmic antibodies, particularly in patients with cardiac involvement.
对钙通道阻滞剂和硝酸盐类药物难治的冠状动脉痉挛可能继发于全身性疾病。嗜酸性肉芽肿性多血管炎（EGPA）虽罕见，但可导致冠状动脉痉挛。
一名33岁女性因反复胸痛导致多次心脏骤停。发现嗜酸性粒细胞增多及冠状动脉内膜增厚，心脏磁共振成像显示有瘢痕形成。鉴于高度怀疑EGPA，她开始接受类固醇治疗及环磷酰胺治疗。经此治疗，她未再出现心脏症状发作。
EGPA累及心脏罕见，预后不良。最常见的心脏表现为充血性心力衰竭、心包炎、心肌炎及心律失常。
对于难治性冠状动脉痉挛且嗜酸性粒细胞计数>10%的患者，鉴别诊断时应考虑EGPA。不能仅因抗中性粒细胞胞浆抗体阴性就排除EGPA，尤其是累及心脏的患者。
