Spastic angina with healthy coronary artery

Spastic Angina with Healthy Coronary Artery is a cardiovascular condition characterized by chest pain or discomfort that occurs due to spasms in the coronary arteries. Unlike typical angina pectoris, which is often due to obstructive coronary artery disease, spastic angina occurs in individuals with angiographically normal or near-normal coronary arteries. This condition is also known as Prinzmetal's angina, variant angina, or vasospastic angina.

Etiology

The exact cause of spastic angina is not fully understood, but it is believed to involve hyperreactivity of the smooth muscle in the coronary arteries, leading to transient spasms. These spasms can reduce or completely block blood flow to parts of the heart muscle, causing the characteristic chest pain. Risk factors may include smoking, stress, exposure to cold, and the use of certain substances like cocaine.

Symptoms

The primary symptom of spastic angina is chest pain, which can be severe and is often described as a constricting, crushing, or burning sensation. The pain typically occurs at rest, often during the early morning hours, and can be relieved by nitroglycerin. Unlike typical angina, the pain associated with spastic angina is not necessarily triggered by physical exertion or stress.

Diagnosis

Diagnosis of spastic angina involves a combination of patient history, physical examination, and diagnostic tests. An electrocardiogram (ECG) may show changes indicative of myocardial ischemia during an episode of chest pain. Coronary angiography is used to confirm the presence of healthy or near-normal coronary arteries and may include a provocation test with agents like acetylcholine to induce and identify coronary artery spasms.

Treatment

Treatment of spastic angina focuses on relieving symptoms and preventing recurrent episodes. This typically involves the use of medications such as calcium channel blockers and nitrates, which help to relax and prevent spasms in the coronary arteries. Lifestyle modifications, including smoking cessation and stress management, are also recommended.

Prognosis

With appropriate treatment, the prognosis for individuals with spastic angina is generally good. However, the condition can be chronic and may require ongoing medication to manage symptoms and prevent complications such as myocardial infarction.