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Vasospastic Angina - Coronary Artery Spasm


Overview, Causes, & Risk Factors

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. Typical angina is linked with physical activity and caused by fat deposits clogging the arteries, or atherosclerosis. Vasospastic angina differs in that it can happen whether a person:

  • is active or resting
  • does or does not have clogged arteries from atherosclerosis
  • When the spasms occur, blood flow to the heart lessens. This causes the pain and raises the risk of a heart attack.

    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
  • Sometimes, strenuous activity can bring on an attack.


    Symptoms & Signs

    What are the signs and symptoms of the condition?

    Symptoms of vasospastic angina are similar to those of typical angina:

  • chest pain
  • shortness of breath
  • rapid heartbeats called palpitations
  • These symptoms occur:

  • at rest
  • during sleep
  • with or without physical exertion

  • Diagnosis & Tests

    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. However, some people with this disease also have blocked coronary arteries.

    An electrocardiogram, or 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.


    Prevention & Expectations

    What can be done to prevent the condition?

    Generally, nothing can be done to prevent the condition.

    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
  • What are the risks to others?

    There are no risks to others.


    Treatment & Monitoring

    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
  • use alcohol in moderation
  • 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
  • What happens after treatment for the condition?

    Uncomplicated cases are usually well controlled with heart medication.

    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.


    Attribution

    Author:Eric Berlin, MD
    Date Written:
    Editor:Coltrera, Francesca, BA
    Edit Date:06/23/00
    Reviewer:Vincent J. Toups, MD
    Date Reviewed:06/01/01

    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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