Coronary Artery Spasm

Coronary artery spasm is a type of angina. It is also called vasospastic, variant, or Prinzmetal angina. Angina is pain that is caused by the heart muscles not receiving enough blood. A sudden spasm or narrowing of a blood vessel that supplies the heart causes angina by reducing the amount of oxygen the heart receives. Coronary artery spasms often cause pain. Sometimes severe spasms can lead to irregular heartbeats. They can even cause heart attack, also known as acute myocardial infarction (AMI), and sudden death. This sheet tells you more about coronary artery spasm. It also explains how the condition is diagnosed and treated.

How Coronary Artery Spasm Differs from Other Anginas

Coronary artery spasm occurs when the wall of an artery contracts suddenly, narrowing the artery.

This condition is rare and occurs more commonly in males than in females. It differs from other types of angina. To start, other types of angina commonly occur when the person is active and tend to occur in people with coronary artery disease (CAD). With CAD, arteries in the heart have a buildup of a fatty substance called plaque. In contrast, coronary artery spasm most often occurs when the person is resting. In fact, it often occurs at night during sleep, usually between midnight and early morning. Also, it tends to occur in younger patients with only minor plaque buildup in arteries in the heart. 

Symptoms of Coronary Artery Spasm

The main symptom is a squeezing, crushing, or burning feeling in the chest. It is temporary, often lasting 5 to 30 minutes. Loss of consciousness may also occur. In some cases, there are no symptoms (a “silent” spasm).

Risk Factors for Coronary Artery Spasm

Risk factors are things that make you more likely to have a certain condition. Coronary artery spasm has several key risk factors. These include:

• Smoking (the most significant risk factor)

• Coronary atherosclerosis

• Genetics

• Insulin resistance

But coronary artery spasm often occurs in people without these risk factors.

Triggers for Coronary Artery Spasm

Triggers are things that can prompt a spasm to occur. These can include:

• Smoking

• Use of stimulant drugs (such as cocaine and amphetamines)

• Changes in heart rate regulation by the nervous system

• magnesium deficiency

• Emotional stress

• Alcohol use

• Exposure to cold

• Migraines

• Use of medications that cause narrowing of the blood vessels

Diagnosis of Coronary Artery Spasm

The doctor will take a health history and ask you to describe your symptoms. You’ll have a physical exam and certain tests may be done. These include:

• Electrocardiogram (ECK or EKG). This test records the electrical activity of your heart. An ECG can detect an abnormal pattern, particularly during the chest pain episode. It can also detect an irregular heart rhythm associated with coronary artery spasm.

• Coronary angiography. This is a special type of X-ray. It creates pictures of your coronary arteries. These pictures show any narrowing or blockage in these blood vessels. This is the gold standard for confirming the diagnosis of coronary artery spasm.

Treatment of Coronary Artery Spasm

There are two main types of treatment for coronary artery spasm.

• Medications, the primary treatment, include:

  • Calcium channel blockers. These can help prevent spasms. Medications called long-acting nitrates may be prescribed for use with calcium channel blockers.

  • Nitroglycerin. This can help ease the pain of a spasm once it’s begun.

If you are prescribed these or any other medications, follow your doctor’s instructions on how and when to take them.

• Lifestyle changes can also help prevent spasms. Start by avoiding the triggers listed above. Also, talk to your doctor about what you can do to reduce your risk of CAD. This may include an improved diet and an exercise plan. If you smoke, your doctor will talk with you about ways to stop.