Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jun 9:17:e07.
doi: 10.15420/usc.2022.33. eCollection 2023.

Invasive Evaluation for Coronary Vasospasm

Jingwen Huang  1 , Rebecca Steinberg  1 , Matthew J Brown  2 , Stéphane Rinfret  2   3 , Olga Toleva  2   3
Affiliations
Review

Invasive Evaluation for Coronary Vasospasm

Jingwen Huang et al. US Cardiol. .

Abstract

Vasospastic angina (VSA) occurs at rest and on exertion, with transient electrocardiographic ischemic changes. VSA presents with spontaneous coronary artery spasm (CAS); it has been associated with stable angina, acute coronary syndromes, and sudden cardiac death. CAS can be identified in normal arteries or non-obstructive coronary atherosclerosis, but is also prevalent in patients with coronary artery disease. The diagnosis is made with invasive coronary reactivity testing with provocation using acetylcholine (Ach). Epicardial spasms can be visualized through coronary angiography as a reversible epicardial vessel narrowing, while the diagnosis of microvascular spasm can be made when angina symptoms and ECG changes happen following intracoronary Ach without epicardial spasm. Identification of CAS allows for risk stratification and specific therapies targeting endothelial dysfunction and paradoxical vascular smooth muscle cell constriction. Therapies include calcium channel blockers as monotherapy or in a combination of a dihydropyridine and non-dihydropyridine. Short-acting nitrates offer acute symptomatic relief but long-acting nitrates should be used sparingly. This current update on invasive evaluation of VSA discusses unified Ach protocols.

Keywords: Coronary vasospasm; MI with non-obstructive coronary arteries; acetylcholine; coronary reactivity testing; ischemia with non-obstructive coronary arteries.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Procedural Steps for Coronary Function Testing
Figure 2:
Figure 2:. Spasm Provocation Testing with Incremental Doses of Acetylcholine
Figure 3:
Figure 3:. Case Example of Induced Coronary Spasm with Acetylcholine
See this image and copyright information in PMC

References

    1. Prinzmetal M, Kennamer R, Merliss R et al. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med. 1959;27:375–88. doi: 10.1016/0002-9343(59)90003-8. - DOI - PubMed
    1. Nakamura M, Takeshita A, Nose Y. Clinical characteristics associated with myocardial infarction, arrhythmias, and sudden death in patients with vasospastic angina. Circulation. 1987;75:1110–6. doi: 10.1161/01.cir.75.6.1110. - DOI - PubMed
    1. Oliva PB, Potts DE, Pluss RG. Coronary arterial spasm in prinzmetal angina. Documentation by coronary arteriography. N Engl J Med. 1973;288:745–51. doi: 10.1056/NEJM197304122881501. - DOI - PubMed
    1. Ford TJ, Rocchiccioli P, Good R et al. Systemic microvascular dysfunction in microvascular and vasospastic angina. Eur Heart J. 2018;39:4086–97. doi: 10.1093/eurheartj/ehy529. - DOI - PMC - PubMed
    1. Cenko E, Bergami M, Varotti E, Bugiardini R. Vasospastic angina and its relationship with the coronary microcirculation. Curr Pharm Des. 2018;24:2906–10. doi: 10.2174/1381612824666180625150833. - DOI - PubMed

LinkOut - more resources