Coronary artery vasospasm: Difference between revisions

(Created page with "==Background== ==Clinical Features== ==Differential Diagnosis== ==Diagnosis== ==Management== ==Disposition== ==See Also== ==External Links== ==References== <re...")
 
No edit summary
Line 1: Line 1:
==Background==
==Background==
 
*Typically affects patients <50 yo
*Severe CP; often without exertion
*A/w transient ST deviation; typically local distribution
*Typically occur in early morning <ref> Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med. 1959;27:375-88.</ref>
*Stress testing often non-diagnostic <ref>Stern SS. Coronary artery spasm: a 2009 update.. Circulation (New York, N.Y.). 2009-05;119:2531-2534.</ref>
*Mechanism is likely vagal withdrawal
*Tobacco use a major risk factor<ref> Takaoka K. Comparison of the risk factors for coronary artery spasm with those for organic stenosis in a Japanese population: role of cigarette smoking. Int J Cardiol. 2000;72:121–126.</ref>
*May be a/w migraines <ref> Rosamond W. Are migraine and coronary heart disease associated? An epidemiologic review. Headache. 2004;44 Suppl 1:S5-12. </ref>
*Resultant infarction are typically small
*Vfib, tachycardia, and complete AV block may be a/w ischemic episodes


==Clinical Features==
==Clinical Features==
 
*Chest discomfort/tightness/pressure
*Gradual onset/resolution
*No respirophasic component to pain
*Poorly localized; radiation of pain is common
*a/w nausea, diaphroesis, and palpations
*Attacks may be precipitated by hyperventilation
*Often no exertional component to CP


==Differential Diagnosis==
==Differential Diagnosis==
 
*Acute pericarditis
*Anxiety disorder
*Aortic dissection
*Cocaine toxicity
*Esophageal spasm
*MI
*Unstable angina
*Cardiac X syndrome


==Diagnosis==
==Diagnosis==
 
*EKG
*CXR
*Holter monitor
*Stress testing typically done to evaluate for fixed CAD, though prinzmetal angina often yields negative results
*Coronary angiography considered in following patients:<ref> Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003.</ref>
**ECG with STE
**History strongly indicative and stress testing/ambulatory monitoring are normal


==Management==
==Management==
 
*SLN
*Counsel on smoking cessation
*For chronic management
**Diltiazem 240-360 mg/day
**Isosorbide mononitrate considered 2nd line due to adverse effect profile
*Avoid nonselective beta blockers as they may exacerbate vasospasm <ref>Robertson RM, Wood AJ, Vaughn WK, Robertson D. Exacerbation of vasotonic angina pectoris by propranolol. Circulation. 1982;65(2):281-5. </ref>
*ASA used with caution and at low dose in pts without h/o CAD <ref>Miwa K, Kambara H, Kawai C. Effect of aspirin in large doses on attacks of variant angina. Am Heart J. 1983;105(2):351-5.</ref>


==Disposition==
==Disposition==

Revision as of 05:26, 18 September 2015

Background

  • Typically affects patients <50 yo
  • Severe CP; often without exertion
  • A/w transient ST deviation; typically local distribution
  • Typically occur in early morning [1]
  • Stress testing often non-diagnostic [2]
  • Mechanism is likely vagal withdrawal
  • Tobacco use a major risk factor[3]
  • May be a/w migraines [4]
  • Resultant infarction are typically small
  • Vfib, tachycardia, and complete AV block may be a/w ischemic episodes

Clinical Features

  • Chest discomfort/tightness/pressure
  • Gradual onset/resolution
  • No respirophasic component to pain
  • Poorly localized; radiation of pain is common
  • a/w nausea, diaphroesis, and palpations
  • Attacks may be precipitated by hyperventilation
  • Often no exertional component to CP

Differential Diagnosis

  • Acute pericarditis
  • Anxiety disorder
  • Aortic dissection
  • Cocaine toxicity
  • Esophageal spasm
  • MI
  • Unstable angina
  • Cardiac X syndrome

Diagnosis

  • EKG
  • CXR
  • Holter monitor
  • Stress testing typically done to evaluate for fixed CAD, though prinzmetal angina often yields negative results
  • Coronary angiography considered in following patients:[5]
    • ECG with STE
    • History strongly indicative and stress testing/ambulatory monitoring are normal

Management

  • SLN
  • Counsel on smoking cessation
  • For chronic management
    • Diltiazem 240-360 mg/day
    • Isosorbide mononitrate considered 2nd line due to adverse effect profile
  • Avoid nonselective beta blockers as they may exacerbate vasospasm [6]
  • ASA used with caution and at low dose in pts without h/o CAD [7]

Disposition

See Also

External Links

References

  1. ↑ Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N. Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med. 1959;27:375-88.
  2. ↑ Stern SS. Coronary artery spasm: a 2009 update.. Circulation (New York, N.Y.). 2009-05;119:2531-2534.
  3. ↑ Takaoka K. Comparison of the risk factors for coronary artery spasm with those for organic stenosis in a Japanese population: role of cigarette smoking. Int J Cardiol. 2000;72:121–126.
  4. ↑ Rosamond W. Are migraine and coronary heart disease associated? An epidemiologic review. Headache. 2004;44 Suppl 1:S5-12.
  5. ↑ Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003.
  6. ↑ Robertson RM, Wood AJ, Vaughn WK, Robertson D. Exacerbation of vasotonic angina pectoris by propranolol. Circulation. 1982;65(2):281-5.
  7. ↑ Miwa K, Kambara H, Kawai C. Effect of aspirin in large doses on attacks of variant angina. Am Heart J. 1983;105(2):351-5.
Retrieved from "https://www.wikem.org/w/index.php?title=Coronary_artery_vasospasm&oldid=46484"