Coronary Artery Spasm as a Contributor to Heart Failure: Lessons from Three Cases

Coronary artery spasm (CAS) is an underrecognized cause of heart failure, even in the absence of obstructive coronary artery disease. We report three cases of heart failure in which CAS was identified as the critical etiology. All patients exhibited symptoms of heart failure with nonobstructive coronary arteries, and CAS provocation testing confirmed epicardial spasm. In two cases, cardiac magnetic resonance imaging revealed ischemic patterns consistent with CAS-related injuries. Calcium channel blockers effectively stabilize the signs and symptoms related to heart failure. This series highlights CAS as a contributor to heart failure progression and emphasizes the importance of provocation testing and early tailored therapy for improving outcomes.