Coronary artery spasm

Causes and Risks:
Coronary artery spasm is a cause of ischemia (inadequate oxygen levels) of the heart. It affects approximately 4 out of 100,000 people. The arteries affected may be normal or they may be "hardened" (atherosclerotic). Spasm may be "silent"--without symptoms--or it may result in stable angina or unstable angina pain. Prolonged spasm may even cause heart attack .

Coronary artery spasm may occur spontaneously, or it may be caused by exposure to cold, emotional stress , or vasoconstricting medications. Cocaine use can cause severe spasm of the arteries while at the same time increasing the energy requirements of the heart. Variant angina is a syndrome, probably involving coronary artery spasm, where the angina pain does not have the usual triggering activities. It most often affects women under 50.

Prevention:
Prevention varies depending on the cause. Low fat diet and increased excercise may reduce ther risk of atherosclerosis . Avoid cocaine use.

Symptoms:
  • chest pain , angina type
    • under the sternum
    • described as squeezing, constricting, tightness, pressure, crushing
    • may radiate to the neck, jaw, shoulder, arm
    • may occur at rest
    • may occur at the same time each day
    • pain lasts from 5 to 30 minutes
    • pain is relieved by nitroglycerin - sublingual



Signs and Tests:
An examination is usually inconclusive but may indicate atherosclerosis . A coronary angiography shows spasm when the artery is injected with ergonovine. An ECG may show ischemic changes during chest pain , and it may show arrhythmias or conduction defects. Tests may be done to rule out fixed lesions such as clot or atherosclerosis as the cause of chest pain.

Treatment:
The goal of treatment is to control chest pain and to prevent heart attack . Nitroglycerin or other nitrate medications (see nitrates - oral; nitrates - sublingual) may be prescribed to relieve chest pain. Medications may also include beta blockers.

Prognosis:
Coronary artery spasm is a chronic condition. Symptoms usually respond to treatment. This disorder may indicate a high risk for severe angina or acute MI .

Complications:



Call Your Healthcare Provider:
Call 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 .