Summary about Disease
Coronary artery spasm (also called Prinzmetal's angina, variant angina, or vasospastic angina) is a temporary tightening (spasm) of the muscles in the wall of a coronary artery. This spasm can severely restrict blood flow to the heart muscle, causing chest pain (angina). It often occurs at rest, frequently between midnight and early morning. While it can occur in people with significant coronary artery disease, it can also occur in those with relatively normal arteries.
Symptoms
Chest pain (angina), often severe and occurring at rest (typically between midnight and early morning).
Pain may radiate to the left arm, shoulder, neck, jaw, or back.
Shortness of breath.
Lightheadedness or dizziness.
Nausea.
Sweating.
Palpitations (feeling like your heart is racing or fluttering).
Fainting (in severe cases).
Causes
The exact cause isn't always clear, but possible causes and risk factors include:
Spasm of the smooth muscle in the artery wall: The primary mechanism.
Endothelial dysfunction: Problems with the inner lining of the artery.
Increased sensitivity to substances that cause vasoconstriction (narrowing of blood vessels): such as epinephrine or serotonin.
Cold weather exposure.
Emotional stress.
Smoking: A significant risk factor.
Cocaine use.
Hyperventilation.
Certain medications: such as triptans (used for migraines) or chemotherapy drugs.
Underlying atherosclerosis (hardening of the arteries): Although spasms can occur in normal arteries, they are more common in those with atherosclerosis.
Medicine Used
Nitrates (e.g., nitroglycerin, isosorbide dinitrate, isosorbide mononitrate): Relax and widen blood vessels to improve blood flow to the heart. Often used for immediate relief during an episode and for prevention.
Calcium channel blockers (e.g., amlodipine, diltiazem, verapamil): Relax the muscles of the artery walls, preventing spasms. These are often used for long-term management.
Ranolazine: May be used in combination with calcium channel blockers or nitrates when those medications are not effective enough on their own.
Statins: (Even if cholesterol levels are normal) Statins may improve endothelial function and reduce the frequency of spasms.
Aspirin: May be prescribed in low doses to help prevent blood clots, especially if atherosclerosis is present.
Is Communicable
No, coronary artery spasm is not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
Quit smoking: This is a critical step to reduce the risk of spasms.
Avoid exposure to cold weather: Dress warmly in cold weather.
Manage stress: Use stress-reduction techniques like exercise, yoga, meditation, or deep breathing.
Avoid cocaine use and other illicit drugs.
Discuss medications with your doctor: Some medications can trigger spasms.
Follow your doctor's instructions: Take prescribed medications as directed.
Maintain a healthy lifestyle: Eat a healthy diet and exercise regularly (as appropriate for your condition).
Learn to recognize the symptoms: and know when to seek medical attention.
Avoid triggers: If you know what triggers your spasms, try to avoid them.
How long does an outbreak last?
An individual coronary artery spasm typically lasts only a few minutes (usually 5-15 minutes). However, the chest pain and associated symptoms can persist for a longer period afterward. The frequency of spasms varies greatly from person to person; some may experience them rarely, while others may have them several times a day.
How is it diagnosed?
Medical history and physical exam: Your doctor will ask about your symptoms, risk factors, and medical history.
Electrocardiogram (ECG or EKG): This test records the electrical activity of your heart. During a spasm, an ECG may show characteristic changes. However, it can be normal if performed when you are not experiencing a spasm.
Ambulatory ECG monitoring (Holter monitor): This device records your heart's electrical activity over 24-48 hours, which may capture a spasm if it occurs during that time.
Coronary angiography (Cardiac Catheterization): This is the most definitive test. A catheter is inserted into a blood vessel and guided to the coronary arteries. Dye is injected, and X-rays are taken to visualize the arteries. The doctor may administer a medication (such as ergonovine or acetylcholine) during the procedure to try to provoke a spasm.
Echocardiogram: An ultrasound of the heart. While it won't directly diagnose coronary spasm, it can rule out other heart conditions.
Blood tests: Blood tests are done to rule out other conditions that can cause chest pain.
Timeline of Symptoms
Sudden onset of chest pain: Typically at rest, often between midnight and early morning.
Pain intensifies rapidly: Reaching its peak within a few minutes.
Symptoms persist for 5-15 minutes: (typical duration of the spasm itself), but pain can linger longer.
Symptoms subside spontaneously: Or with the use of nitroglycerin.
Symptoms recur intermittently: The frequency varies significantly from person to person.
Important Considerations
Seek immediate medical attention: If you experience chest pain, especially if it's new or different from what you've experienced before.
Coronary artery spasm can be life-threatening: because it can lead to serious heart problems such as heart attack or arrhythmia (irregular heartbeat).
Accurate diagnosis is crucial: To differentiate coronary artery spasm from other causes of chest pain, such as stable angina or a heart attack.
Long-term management is important: To prevent future spasms and reduce the risk of complications.
Lifestyle modifications are essential: To reduce risk factors and improve overall heart health.
Regular follow-up with your cardiologist is necessary: To monitor your condition and adjust your treatment plan as needed.
It is important to note that coronary artery spasm can occur even in individuals without significant blockages in their coronary arteries.