Definition

Coronary artery spasm is a temporary, abrupt, and focal (restricted to one location) contraction of the muscles in the wall of an artery in the heart, which constricts the artery. This slows or stops blood flow through the artery during the spasm.

Alternative Names

Variant angina; Angina - variant

Causes

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.

The arteries affected may be normal but much more often, they are "hardened" (atherosclerotic). Spasm may be "silent" -- without symptoms -- or it may result in stable angina or unstable angina. The most typical manifestation of coronary spasm is variant angina (see below). Prolonged spasm may even cause a heart attack.

Coronary artery spasm may occur spontaneously, or it may be caused by exposure to cold, emotional stress, alcohol withdrawal, or vasoconstricting medications. Cocaine use and cigarette smoking can cause severe spasm of the arteries while at the same time increasing the energy requirements of the heart.

Variant angina is a type of chest pain, probably involving coronary artery spasm, where the angina pain is triggered by rather unusual factors. It most often affects women under 50, but can also affect men.

Symptoms

The main symptom is angina (a type ofchest pain), with these characteristics:

Under the chest bone
Described as squeezing, constricting, tightness, pressure, crushing -- it is usually severe and may radiate to the neck, jaw, shoulder, or arm
It often occurs at rest
May occur at the same time each day, usually between midnight and 8:00 AM
Pain lasts from 5 to 30 minutes
Pain is relieved by nitroglycerin
Syncope (loss of consciousness) can accompany the angina

Exams and Tests

An examination is usually inconclusive, but may indicate atherosclerosis. Coronary angiography may show spasm when the artery is injected with ergonovine, and may show fixed lesions, such as clot or atherosclerosis, which contribute to chest pain.

An ECG may show ischemic changes during chest pain, and it may show arrhythmias or conduction defects.

Treatment

The goal of treatment is to control chest pain and to prevent heart attack. Nitroglycerin or other nitrate medications may be prescribed to relieve chest pain. Calcium-channel blockers may be chronically needed.

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

Outlook (Prognosis)

Coronary artery spasm is achronic condition. Symptoms usually respond to treatment. This disorder may indicate a high risk for acute MI (heart attack) or potentially fatal arrhythmias. However, the prognosis is generally good if the patient is treated and avoids certain triggers.

Possible Complications

Acute MI (heart attack)
Arrhythmias

When to Contact a Medical Professional

Call your health care provider if crushing or heavy chest pain occurs, or if chest pain does not respond to nitroglycerin in people with a prior history of angina.

Prevention

Prevention can be directed against progression of coronary atherosclerosis and against known angina triggers. Low-fat diet and increased exercise may reduce the risk of atherosclerosis. Exposure to cold, cocaine use, cigarette smoking, and high stress situations should be avoided in patients suspected of having coronary spasm.