Coronary artery spasms (Coronary Vasospasm) are also called vasospastic angina or prinzmetal angina. In this condition, a segment of the artery which takes blood to the heart becomes constricted and narrowed. Due to arteries spasm, the heart must work harder, forcing it to pump blood through the afflicted location.
Spastic episodes are normally short, but they can remain for more than 15 minutes. In most cases, you will not feel any pain or discomfort while experiencing these spasms. However, sometimes, it can lead to serious issues such as chest pain, heart attacks, or even death. Healthcare professionals face a challenge in detecting and diagnosing this condition accurately. Several other factors cause heart illness and chest pain, so it may be difficult for physicians to differentiate coronary artery spasms from other causes. Usually, the sufferers of coronary artery spasms do not encounter any signs. On the other hand, if they experience signs, it may also be challenging to link the symptoms with the underlying cause unless a healthcare provider takes a test during the spasm.
Causes of Coronary Vasospasm:
The spasm can exist in coronary arteries irrespective of the plaque accumulation in the artery wall. Due to muscles compressing the artery walls, spasms occur in a particular region of the artery.
About 2% of people with angina (chest pain and stress) suffer from coronary artery spasms. Those who have high cholesterol or high BP are more likely to experience a coronary artery spasm. The condition may arise spontaneously or may be triggered by the following factors:
- The withdrawal effects of alcohol
- Emotional distress
- Cold exposure
- Vasoconstriction medications cause the blood vessels to narrow
- Drugs that stimulate the central nervous system, such as amphetamines and cocaine
Tobacco and cocaine usage may become the reason for serious spasms of the arteries. While, coronary artery spasms can also happen without other cardiovascular risks such as the use of tobacco, sugar, high BP, or high cholesterol).
Symptoms of Coronary vasospasm:
Coronary artery spasms usually go undetermined because they do not normally manifest themselves as signs. It can be harmful as the contractions may lead to a myocardial infraction. Following are the symptoms of coronary artery spasms.
- Angina or chest pain
- Discomfort on the left side of the chest
- Rigidness in the chest
- Feel of shrinking
You may even encounter pain that radiates from your chest to your arms, neck, or jawbone. You may also have coronary artery spasms if you experience chest pain that:
- Occurs during rest only
- Remains for a period of five to thirty minutes
- Occurs primarily at night and in the early hours of the morning
In severe stages, an individual may encounter stark, long-lasting chest pain, cold sweat, nausea, and vomiting. Moreover, there is a possibility of experiencing a temporary loss of consciousness and a sense of muscle pain in the arm or jaw caused by spasms.
Risk factors:
If you have a greater risk of heart disease, the probability of developing coronary artery spasms will be higher. High BP and high cholesterol levels are directly proportional to arterial shrinking. Following are certain other things that put you at risk for coronary artery spasms:
- Tobacco
- Excessive usage of stimulants, such as cocaine and amphetamines
- Excess stress
- Too much cold
- Withdrawal from alcohol
Diagnosis of Coronary Vasospasm:
Coronary artery spasms indicate the probability of heart problems. Due to this, your physician will likely order various imaging tests to understand your heart better and develop a treatment plan accordingly. Several types of diagnostic imaging tests may perform:
- Echocardiogram: It is a diagnostic ultrasound test that creates images of your heart using sound waves.
- Electrodiagram: Electrocardiogram (EKG) is a test that measures electrical activity in the heart.
- Coronary Angiography: An angiography involves the use of dye to visualize the internal part of your arteries and figure out the blood flow through your heart by using a particular X-ray test.
Treatment of Coronary Vasospasm:
Treatments aim to relieve chest pain and prevent occurring of spasms. In case of spasm, nitroglycerin (Nitrostat) is mostly used to widen arteries for improved blood flow and relieve chest pains.
To prevent spasms in long run, your healthcare provider may prescribe the below-mentioned medicines:
- A calcium channel blocker, like amlodipine (Norvasc), diltiazem (Cardizem), or nifedipine (Procardia) is used to relax your arteries.
- In addition to lowering your cholesterol, statins, such as atorvastatin (Lipitor®) and simvastatin (Zocor®) may also prevent spasms.
In some cases, coronary artery spasms can lead to an irregular heart rhythm in your lower heart chambers (ventricular arrhythmia). For this, your physician will likely recommend having an implantable cardioverter-defibrillator (ICD) to prevent severe complications. Integrated cardioverter defibrillators (ICDs) use electrical signals to keep your heartbeat in a regular rhythm.
Complications:
Spasms of the coronary arteries are not long-lasting but can have long-term adverse consequences. In the absence of treatment, coronary artery spasms are more likely to occur and can cause:
- Heart Arrhythmia: It means the heart beats abnormally or too quickly, or too slowly.
- A heart attack: It occurs by the complete obstruction of blood circulation to the heart.
- Cardiac arrest: It happens when your heart stops beating suddenly due to insufficient blood flow to your brain.
- Death
Preventions:
Even though it may not always be feasible to anticipate coronary artery spasms in advance; removing certain risk factors may help in minimizing their occurrence. It includes;
- Smoking: An individual can minimize smoking or quit altogether to prevent coronary artery spasms.
- Alcohol: Stop alcohol intake may also be effective in preventing various types of cancer.
- Beta-blockers: Physicians are usually recommended medicines like calcium channel blockers, nitrates, and statins to stop further signs.
- Avoid medicines: Persons with coronary heart spasms should avoid or limit the consumption of the following medicines:
- Nonselective beta-blockers: The medications such as propranolol may aggravate coronary artery spasms.
- Aspirin: Taking a great amount of aspirin stops the production of prostacyclin. People who suffer from coronary heart spasms must take a low dosage of medicine under a doctor’s prescription and monitoring. The recommended dosage is 75 to 81 milligrams per day.
- Oral sumatriptan: Sumatriptan is an oral migraine treatment that can cause coronary vasospasms or heart attacks. In case of known or suspected coronary artery spasms, you must avoid all triptans.
- Fluorouracil: It is also known as 5-fluorouracil may cause nausea and vomiting
References:
- https://www.medicalnewstoday.com/articles/322128#what-is-it
- https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/coronary-artery-spasm
- https://www.healthline.com/health/coronary-artery-spasm#risk-factors
- https://my.clevelandclinic.org/health/diseases/16900-coronary-spasm
