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Coronary Artery Spasm

Alternate Names

  • vasospastic angina
  • variant angina
  • Prinzmetal's angina
  • Coronary arteries

Definition

The coronary arteries are a pair of blood vessels that carry oxygen-rich blood to the heart muscles. A spasm in these arteries known as a vasospasm reduces blood flow to the heart. This causes a chest pain called angina.

What is going on in the body?

Most often, vasospastic angina occurs while a person is at rest, or it wakes a person from sleep. This is in contrast to typical angina caused by clogged arteries (atherosclerosis), which more often comes on with exercise. Vasospastic angina can, however, happen whether a person is active a resting and regardless of the presence of atherosclerosis.
When the spasms occur, blood flow to the heart is reduced. This causes the pain and raises the risk of a heart attack.

Risks

What are the causes and risks of the condition?

The coronary arteries and other blood vessels may constrict due to:
  • certain medications, such as vasopressin or ergonovine
  • cocaine
  • exposure to cold
  • high levels of stress
  • nicotine
Sometimes, strenuous activity can bring on an attack.

Prevention

What can be done to prevent the condition?

Generally, nothing can be done to prevent the condition.

Diagnosed

How is the condition diagnosed?

A healthcare provider may suspect coronary artery spasms based on a person's symptoms. A pattern of chest pain at rest, for example, is suspicious, especially if a person has no history of blocked coronary arteries or heart attack. An electrocardiogram (ECG) may be normal between attacks. During attacks, the ECG may record changes that show a lack of blood flow to the heart. A procedure called a cardiac catheterization can find clogged blood vessels. Often, vasospastic angina can be diagnosed only after other possibilities have been excluded.

Long Term Effects

What are the long-term effects of the condition?

A person with coronary artery spasms has a higher risk of:
  • irregular heart rhythms, or arrhythmias
  • heart attack
  • sudden death

Other Risks

What are the risks to others?

There are no risks to others.

Treatments

What are the treatments for the condition?

If a person has severely blocked coronary arteries, surgery may stop the vasospasms. Those who have fewer symptoms and no coronary artery blockages respond well to heart medication.
A person should also:
  • eat a healthy diet, following the Food Guide Pyramid
  • exercise regularly
  • quit smoking
  • avoid excessive use of alcohol

Side Effects

What are the side effects of the treatments?

All medications have side effects. Medications used to treat coronary artery spasm may cause
  • headache
  • fatigue
  • sleep disorders such as insomnia
  • dizziness
  • serious arrhythmias

After Treatment

What happens after treatment for the condition?

Uncomplicated cases are usually well controlled with heart medication.

Monitor

How is the condition monitored?

Monitoring includes:
  • blood tests
  • ECG tests
  • stress tests, or an ECG of the heart's function during exercise
A person should report any change in the pattern or severity of chest pains to his or her healthcare provider right away.

Sources

Merck Manual 1999

Current Medical Diagnosis and Treatment 1996

Harrison's Principles of Internal Medicine 1991

Heart Disease: A Textbook of Cardiovascular Medicine, 1980

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