Health Encyclopedia

Coronary artery spasm

Definition

Coronary artery spasm is a temporary, sudden contraction in one location in the muscles in the wall of an artery in the heart. The spasm slows or stops blood flow through the artery and starves the heart of oxygen-rich blood.

Alternative Names

Variant angina; Angina - variant; Prinzmetal's angina

Causes, incidence, and risk factors

The spasm may occur in arteries that appear normal or it may take place in arteries that have turned hard due to plaque build up (atherosclerosis).

Coronary artery spasm is a cause of inadequate oxygen levels (ischemia) of the heart. It affects approximately 4 out of 100,000 people, and affects approximately 2% of patients with angina.

Spasm may be "silent" -- without symptoms -- or it may result in persons with stable angina or unstable angina. It is usually appears as variant angina, a type of chest pain that is thought to be due to endothelial dysfunction, a condition in which the coronary artery may appear normal, but does not function normally.

Prolonged spasm may even cause a heart attack.

Coronary artery spasm may occur without cause, or it may be triggered by:

Alcohol withdrawal
Emotional stress
Exposure to cold
Medications that cause narrowing of the blood vessels (vasoconstriction)

Cocaine use and cigarette smoking can cause severe spasm of the arteries while also causing the heart to work harder. In many people, coronary artery spasm may occur without any other heart risk factors( such as smoking, diabetes, high blood pressure, and high cholesterol).

Symptoms

The main symptom is type of chest pain called angina, which can be felt under the chest bone and is described as:

Constricting
Crushing
Pressure
Squeezing
Tightness

It is usually severe. The pain may spread to the neck, jaw, shoulder, or arm.

The pain:

Often occurs at rest
May occur at the same time each day, usually between midnight and 8:00 AM.
Lasts from 5 to 30 minutes

The person may lose consciousness.

Signs and tests

Tests to diagnose coronary artery spasm may include:

Treatment

The goal of treatment is to control chest pain and to prevent heart attack. The pain is relieved by a medicine called nitroglycerin.

Other medications may be prescribed to relieve chest pain. Calcium channel blockers may be needed long term.

Medications may also include beta-blockers. However, in some cases of variant angina, beta-blockers may be harmful (especially if used along with cocaine).

Expectations (prognosis)

Coronary artery spasm is a chronic condition. However, treatment usually helps control symptoms.

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 doctor's treatment recommendations and avoid certain triggers.

Complications

Abnormal heart rhythms
Heart attacks

Calling your health care provider

Immediately call your local emergency number (such as 911) or go to the hospital emergency room if you have a history of angina and the crushing or squeezing chest pain is not relieved by nitroglycerin. The pain may be due to a heart attack. Rest and nitroglycerin do not completely relieve the pain of a heart attack.

A heart attack is a medical emergency. If you have symptoms of a heart attack, seek immediate medical help.

Prevention

Prevention involves avoiding triggers and taking measures to reduce your risk of atherosclerosis. This may a low-fat diet and increased exercise.

If you have this condition, you should avoid exposure to cold, cocaine use, cigarette smoking, and high stress situations, which can trigger a spasm.

References

Cannon CP, Braunwald E. Unstable angina and non-ST elevation myocardial infarction. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders; 2007:chap 53.

Review Date:5/19/2008
Reviewed By:Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, and Private practice specializing in Cardiovascular Disease, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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