What Is Coronary Vasospasm?

Coronary spasm refers to the transient contraction of coronary arteries caused by various causes, causing incomplete or complete occlusion of blood vessels, leading to myocardial ischemia, clinical syndromes of angina pectoris, arrhythmia, myocardial infarction and sudden death . It has important clinical significance for the diagnosis, treatment and prognosis of myocardial ischemic disease. Frequent episodes and severe symptoms are associated with arrhythmias, atrioventricular block, and heart failure, as well as poor prognosis for those who are poorly treated with nitrate and calcium antagonist drugs.

Basic Information

English name

Coronaryspasm

Visiting department

Cardiology

Common locations

Coronary arteries

Common symptoms

Angina pectoris, arrhythmia, myocardial infarction and sudden death

Causes of coronary artery spasm and common diseases

Variant angina pectoris

Coronary angiography confirmed that the cause of variant angina is mainly coronary artery spasm. There are two types of variant angina pectoris: one occurs on the basis of coronary atherosclerosis, and the other occurs on normal coronary arteries.

2. Labor-type angina pectoris

Angina pectoris that occurs during exercise. Coronary angiography confirmed the presence of coronary spasm during this type of attack. Myocardial oxygen consumption increases during labor, the myocardial oxygen supply and demand imbalance occurs, and vascular spasm further aggravates myocardial ischemia and causes angina pectoris.

3. Unstable angina pectoris

This type of angina pectoris is associated with the rapid progression of atherosclerotic lesions. However, there are also factors of coronary spasm. Patients with normal coronary arteries may also be unstable due to recurrent spasms.

4. Acute myocardial infarction

Coronary atherosclerosis is prone to vasospasm, which causes the lumen to become completely blocked from partial blockage, resulting in myocardial infarction. The normal coronary artery causes myocardial infarction due to continuous spasm, which causes the myocardium to continue to be ischemic. In addition, continuous spasm of the coronary artery causes blood flow stasis and vascular endometrial damage, which promotes platelet aggregation and plaque formation, eventually forming thrombus and myocardial infarction.

5. Sudden death

Coronary artery spasm can cause sudden death in patients with normal coronary arteries and those with coronary atherosclerotic stenosis. The mechanism is fatal arrhythmia, such as ventricular fibrillation, severe atrioventricular block, ventricular arrest.

6. Other common diseases

(1) Diabetic heart disease in the elderly.

(2) Stable angina pectoris.

(3) Alcoholic cardiomyopathy.

(4) Unstable angina pectoris in the elderly.

(5) Asymptomatic myocardial ischemia.

Coronary arterial spasm

ECG examination

Coronary arterial spasm cannot be ruled out in normal subjects. An electrocardiogram cannot pinpoint the exact location or the extent of coronary spasm.

Coronary angiography

Coronary angiography has diagnostic value for coronary spasm. The diagnosis can be confirmed if the following conditions are met: Transient stenosis or complete occlusion of normal coronary arteries, or transient stenosis or complete occlusion of coronary atherosclerotic stenosis. Nitrate or calcium antagonists and other crown-expanding drugs make the aforementioned narrowing or occlusion quickly disappear or disappear on their own.

3. Excitation test

(1) The cold compression test is to stimulate the sympathetic nerves by reflex and induce coronary artery contraction. Both hands were immersed in cold water at 4 to reach the wrist joint. After 1 minute, the clinical symptoms and ECG changes were observed at 1 minute, 2 minutes, 5 minutes, 10 minutes, and 20 minutes. Positive ST-segment elevation and typical myocardial ischemic manifestations were positive. This method is simple and easy to implement, but it is less sensitive.

(2) Ergometrine test During coronary angiography, intramuscular or intracoronary injection of Ergometrine to stimulate coronary spasm. This method has high sensitivity and specificity. However, sometimes severe arrhythmias, myocardial infarction and sudden death can occur. It needs to be done under the conditions of adequate CPR.

4. Heart Nuclide Examination

With iliac myocardial perfusion angiography, it is possible to observe an ischemic insufficiency defect in the ischemic area of the corresponding part during coronary spasm. After the spasm is relieved, myocardial perfusion can be improved.

Differential diagnosis of coronary spasm

Acute pericarditis

Especially acute non-specific pericarditis may have severe and persistent pain in the precardiac area. However, in patients with pericarditis, at the same time or before, they have fever and increased white blood cell count. The pain is often worsened during deep breathing and coughing. Physical examination can find pericardial friction sounds, and the condition is generally not as severe as myocardial infarction.

2. Acute pulmonary embolism

Large pulmonary artery embolism can often cause chest pain, dyspnea, hemoptysis, and shock, but there is a sharp increase in right heart load. Such as the right ventricle sharply enlarged, pulmonary heart valve hyperdiastolic second heart.

3. Acute abdomen

Patients with acute pancreatitis, peptic ulcer perforation, acute cholecystitis, cholelithiasis, etc. may have upper abdominal pain and shock, which may be confused with those of patients with acute myocardial infarction that spread to the upper abdomen. However, it is not difficult to make a careful inquiry about the medical history and physical examination.

4. Aortic dissection

The onset of severe chest pain resembles an acute myocardial infarction. However, the pain peaked at the beginning, often radiating to the back, ribs, abdomen, waist and lower limbs. The blood pressure and pulse of the upper limbs could be significantly different. A few had aortic valve insufficiency, and temporary lower limb paralysis or hemiplegia.

Coronary spasm treatment principles

1. Sublingual mouth contains nitroglycerin. Those who do not relieve can repeat the administration (note blood pressure). Diltiazem and other drugs can also be used. Avoid vasoconstrictor drugs and beta blockers.

2. If severe hypotension occurs, dopamine should be used simultaneously to maintain blood pressure. If cardiac arrest occurs, CPR should be started immediately.