Coronary artery vasospasm
Coronary artery vasospasm - Description, Causes and Risk Factors:
Coronary artery vasospasm, or smooth muscle constriction of the coronary artery, is an important cause of chest pain syndromes that can lead to myocardial infarction (MI), ventricular arrhythmias, and sudden death. It also plays a key role in the development of atherosclerotic lesions.
Coronary artery vasospasm occurs most commonly in people who smoke or who have high cholesterol or high blood pressure. It may occur without cause, or it may be triggered by:
- Emotional stress.
- Exposure to cold.
- Medications that cause narrowing of the blood vessels (vasoconstriction).
- Stimulant drugs such as amphetamines and cocaine.
- The role of genetic factors in the pathogenesis of CAS has also been suggested by the observation of a different prevalence of vasospastic angina in White and Japanese people.
In many cases, coronary artery vasospasm can occur spontaneously without an identifiable cause. Known triggers of spasm in susceptible patients include hyperventilation, cocaine or tobacco use, and administration of provocative agents such as acetylcholine, ergonovine, histamine, or serotonin.
The disorder may be a sign that you have a high risk for heart attacks or potentially deadly irregular heart rhythms (arrhythmias). The outlook is generally good if you follow your physician's treatment recommendations and avoid certain triggers.
Coronary artery vasospasm - Symptoms:
This variant of angina occurs at rest, usually lasting for between 5 and 30 minutes. Most episodes occur between midnight and early morning.
- The pain is often severe and may be associated with palpitations or syncope secondary to arrhythmia.
- A few patients have a general abnormality of vasomotor tone. They may also present with symptoms of migraine headache and Raynaud's phenomenon.
Evaluation of the standard hematology, serum chemistry, and lipid profiles is appropriate for excluding anemia, infection, primary platelet disorders, renal failure, hyperglycemia, electrolyte abnormalities, and dyslipidemia. Serial measurement of cardiac enzyme and troponin levels should be performed to assess for evidence of ischemia.
Magnesium levels may be checked; magnesium deficiency can heighten sensitivity to acetylcholine- and hyperventilation-induced spasm. Magnesium supplementation may be a potentially useful therapy.
Myocardial perfusion imaging may be helpful in ruling out obstructive atherosclerotic disease between episodes of coronary artery vasospasm. During episodes, myocardial perfusion imaging may help identify and quantify ischemia and localize it to the culprit artery.
Standard transthoracic echocardiography should be considered to evaluate for stigmata of other causes of non-exertional chest pain (eg, pericarditis or abnormalities of the aorta). Preliminary data suggest a potential role for hyperventilation and cold-pressor stress echocardiography as a noninvasive means for detecting coronary artery vasospasm, though this method may not be as sensitive as using intracoronary acetylcholine as the provocative agent.
Many episodes of coronary artery vasospasm are brief and may be asymptomatic; however, ST-segment changes may be detected by ambulatory electrocardiography, which may allow for more accurate characterization of the frequency and duration of attacks.
Other tests to diagnose coronary artery vasospasm may include:
The goal of treatment is to control chest pain and prevent a MI. A medicine called nitroglycerin can relieve an episode of pain. Your healthcare provider may prescribe other medications to prevent chest pain. You may need a type of medicine called a calcium channel blocker long-term. Your doctor may prescribe long-acting nitrates along with the calcium channel blocker. Beta-blockers are another type of medication that may be used. However, beta-blockers may make the condition worse and may be harmful if used with cocaine.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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