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Review
. 2023 May 22:18:e38.
doi: 10.15420/ecr.2022.47. eCollection 2023.

Management of Coronary Artery Spasm

Gaetano Antonio Lanza  1 , Hiroaki Shimokawa  2
Affiliations
Review

Management of Coronary Artery Spasm

Gaetano Antonio Lanza et al. Eur Cardiol. .

Abstract

Calcium channel blockers (CCBs) are the first-line treatment for coronary artery spasm (CAS). When CAS-related angina symptoms are not well controlled by CCB therapy, long-acting nitrates or (where available) nicorandil can be added as second-line medications. In the case of CAS refractory to standard treatments, several other alternative drugs and interventions have been proposed, including the Rho-kinase inhibitor fasudil, anti-adrenergic drugs, neural therapies and percutaneous coronary interventions. In patients with syncope or cardiac arrest caused by CAS-related tachyarrhythmias, or even bradyarrhythmias, implantation of an ICD or pacemaker, respectively, should be considered according to the risk of recurrence and efficacy of vasodilator therapy.

Keywords: Coronary artery spasm; treatment; variant angina; vasospastic angina.

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Conflict of interest statement

Disclosures: GAL and HS are on the European Cardiology Review editorial board; this did not influence peer review. The authors have no other conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Three-Channel ST-Segment Trend on 24-h Holter ECG in a Patient with Variant Angina and a ‘Coronary Spasm Storm’
Figure 2:
Figure 2:. General Approach to the Treatment of Patients with Variant/Vasospastic Angina
See this image and copyright information in PMC

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