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Coronary artery spasm
Alternative namesVariant angina; Angina - variant
DefinitionCoronary artery spasm is a temporary, abrupt, and focal (restricted to one location) contraction of the muscles in the wall of an artery in the heart, which constricts the artery. This slows or stops blood flow through the artery during the spasm.
Causes, incidence, and risk factors
Coronary artery spasm is a cause of inadequate oxygen levels (ischemia) of the heart. It affects approximately 4 out of 100,000 people, and affects approximately 2% of patients with angina.
The arteries affected may be normal but much more often, they are "hardened" (atherosclerotic). Spasm may be "silent" -- without symptoms -- or it may result in stable angina or unstable angina . The most typical manifestation of coronary spasm is variant angina (see below). Prolonged spasm may even cause a heart attack .
Coronary artery spasm may occur spontaneously, or it may be caused by exposure to cold, emotional stress , alcohol withdrawal, or vasoconstricting medications. Cocaine use and cigarette smoking can cause severe spasm of the arteries while at the same time increasing the energy requirements of the heart.
Variant angina is a type of chest pain, probably involving coronary artery spasm, where the angina pain is triggered by rather unusual factors. It most often affects women under 50, but can also affect men.
SymptomsThe main symptom is angina (a type of chest pain ), with these characteristics:
Signs and tests
An examination is usually inconclusive, but may indicate atherosclerosis . Coronary angiography may show spasm when the artery is injected with ergonovine, and may show fixed lesions, such as clot or atherosclerosis, which contribute to chest pain.
The goal of treatment is to control chest pain and to prevent heart attack . Nitroglycerin or other nitrate medications may be prescribed to relieve chest pain. Calcium-channel blockers may be chronically needed.
Expectations (prognosis)Coronary artery spasm is a chronic condition. Symptoms usually respond to treatment. This disorder may indicate a high risk for acute MI (heart attack) or potentially fatal arrhythmias. However, the prognosis is generally good if the patient is treated and avoids certain triggers.
Calling your health care providerCall your health care provider if crushing or heavy chest pain occurs, or if chest pain does not respond to nitroglycerin in people with a prior history of angina .
PreventionPrevention can be directed against progression of coronary atherosclerosis and against known angina triggers. Low fat diet and increased exercise may reduce the risk of atherosclerosis . Exposure to cold, cocaine use, cigarette smoking, and high stress situations should be avoided in patients suspected of having coronary spasm.
Update Date: 6/4/2002Samer Garas, M.D., Division of Cardiology, Emory University, Atlanta, GA. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT